Psychological distress,health and treatment-related factors among individuals initiating ART in Oromia,Ethiopia

HIV diagnosis may be a source of psychological distress. Late initiation of antiretroviral therapy (ART) and treatment-related beliefs may intensify psychological distress among those recently diagnosed. This analysis describes the prevalence of psychological distress among people living with HIV (PLWH) and examines the association of recent HIV diagnosis, late ART initiation and treatment-related beliefs with psychological distress. The sample includes 1175 PLWH aged 18 or older initiating ART at six HIV clinics in Ethiopia. Psychological distress was assessed with Kessler Psychological Distress Scale. Scores?≥?29 were categorized as severe psychological distress. Individuals who received their first HIV diagnosis in the past 90 days were categorized as recently diagnosed. Multivariable logistic regression modeled the association of recent diagnosis, late ART initiation and treatment-related beliefs on severe psychological distress, controlling for age, sex, education, area of residence, relationship status, and health facility. Among respondents, 29.5% reported severe psychological distress, 46.6% were recently diagnosed and 31.0% initiated ART late. In multivariable models, relative to those who did not initiate ART late and had longer time since diagnosis, odds of severe psychological distress was significantly greater among those with recent diagnosis and late ART initiation (adjusted OR [aOR]: 1.9 [95% CI 1.4, 2.8]). Treatment-related beliefs were not associated with severe psychological distress in multivariable models. Severe psychological distress was highly prevalent, particularly among those who were recently diagnosed and initiated ART late. Greater understanding of the relationship between psychological distress, recent diagnosis, and late ART initiation can inform interventions to reduce psychological distress among this population. Mental health screening and interventions should be incorporated into routine HIV clinical care from diagnosis through treatment.     

Assessment of Mechanical and Thermal Properties of Hemp-Lime Mortar

The use of renewable and natural materials characterized by the low environmental impact is nowadays a key issue for the sustainable development of the construction industry. For this reason, the interest for natural fibers, to be used as reinforcement in composites as an alternative to other fibers, is continuously growing. In this paper, the use of hemp for reinforcing lime mortar used as plaster is considered with a multidisciplinary approach, taking into consideration the structural and thermal performance. Natural fibers have several advantages compared to industrial ones, such as low cost, low environmental impact, biodegradability, renewable nature. Moreover, these can show remarkable mechanical performance in relation to specific weight, and sometimes, as in the case of hemp fibers, these can improve the thermal insulation capacity of the plaster. However, the experimental results on the mechanical features are still lacking, especially to assess their durability, and the variability of thermal parameters with the mechanical characteristics. Therefore, this paper proposes an experimental program, developed at Laboratory of Materials and Structures (LAMAS) of the University of Sannio (Italy), aimed at investigating the main mechanical properties (compression strength, flexural strength) of lime mortar reinforced by hemp fibers and subjected to various environmental exposures and aging processes. The characterization is completed with the measurement for the produced samples of the thermal conductivity by means of the standardized guarded hot plate technique.     

Assessment of a disease screener by hierarchical all-subset selection using area under the receiver operating characteristic curves

In many clinical settings, a commonly encountered problem is to assess the accuracy of a screening test for early detection of a disease. In this article, we develop hierarchical all-subset variable selection methods to assess and improve a psychosis screening test designed to detect psychotic patients in primary care clinics. We select items from an existing screener to achieve best prediction accuracy based on a gold standard psychosis status diagnosis. The existing screener has a hierarchical structure: the questions fall into five domains, and there is a root question followed by several stem questions in each domain. The statistical question lies in how to implement the hierarchical structure in the screening items when performing variable selection such that when a stem question is selected in the screener, its root question should also be selected. We develop an all-subset variable selection procedure that takes into account the hierarchical structure in a questionnaire. By enforcing a hierarchical rule, we reduce the dimensionality of the search space, thereby allowing for fast all-subset selection, which is usually computationally prohibitive. To focus on prediction performance of a selected model, we use area under the ROC curve as the criterion to rank all admissible models. We compare the procedure to a logistic regression-based approach and a stepwise regression that ignores the hierarchical structure. We use the procedure to construct a psychosis screening test to be used at a primary care clinic that will optimally screen low-income, Latino psychotic patients for further specialty referral.     

Depressive Symptoms,Gender, Disclosure,and HIV Care Stage Among People Living with HIV in Cameroon

AIDS and Behavior - Depression is associated with suboptimal HIV care outcomes. Little is known about the extent to which the prevalence of depressive symptoms varies across the HIV care continuum....     

Household decision-making power and the mental health and well-being of women initiating antiretroviral treatment in Oromia,Ethiopia

Low decision-making power (DMP) has been associated with HIV seropositivity among women in sub-Saharan Africa. As treatment accessibility and life expectancy for HIV-positive individuals increase, greater attention to the mental health and well-being of HIV-positive women is needed. This study examined whether low DMP was associated with psychological distress, social support or health-related quality of life (HRQoL) among women initiating ART. The sample included 722 women aged 18 or older initiating ART during 2012–2013 at six HIV clinics in Oromia, Ethiopia. DMP was assessed with five questions about household resource control and decision-making. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10). HRQoL was assessed with the overall subscale of the HIV/AIDS-Targeted Quality of Life instrument. Multivariable logistic regression analyses controlled for age, education, and location (urban/rural). Most respondents (63%) reported high DMP, followed by medium (27%) and low (10%) DMP. More than half (57%) reported psychological distress. Compared to medium DMP, low DMP among married or cohabitating women was associated with greater odds of low social support (aOR: 1.9 [1.3, 2.9]; high DMP among women not in a relationship was associated with greater odds of low social support (aOR: 4.4 [2.4, 8.1]) and psychological distress (aOR: 1.7 [1.1, 2.6]). Interventions to reduce psychological distress among women initiating ART should consider the familial context, as high DMP among women not in a relationship was associated with psychological distress. High DMP may indicate weak social ties and fewer material resources, particularly among women not in a relationship.     

Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment

BackgroundInadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants.ObjectiveThis study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake.MethodsWe conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered.ResultsOf the 5098 invited cohort participants, 4793 (94.0%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider’s office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing.ConclusionsWe identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines.     

HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo

IntroductionDisclosure of one''s HIV status may decrease depression and improve the quality of life among people living with HIV. However, there is mixed evidence on the impact of disclosure to partners for pregnant women living with HIV (WLHIV) in areas of intersecting social concerns over disclosure and high prevalence of intimate partner violence (IPV). We assessed the association between HIV disclosure and depressive symptoms among pregnant WLHIV in the Democratic Republic of Congo (DRC) and examined whether the knowledge of partner''s status or recent IPV modified this association.MethodsWe utilized data from participants enrolled in a trial to evaluate the effect of continuous quality interventions on long‐term therapy outcomes among HIV‐positive pregnant and breastfeeding women in DRC ({"type":"clinical-trial","attrs":{"text":"NCT03048669","term_id":"NCT03048669"}}NCT03048669). Only pregnant women (n = 1392) were included in this cross‐sectional analysis. Between November 2016 and June 2019, enrolled participants completed a survey that included the Patient Health Questionnaire‐9 (PHQ‐9) to screen recent depressive symptoms, questions about disclosure, knowledge of partner''s status and IPV. We used linear models to calculate crude and adjusted mean differences (MDs) between disclosure and depressive symptoms. All analyses were stratified by timing of HIV diagnosis.ResultsDisclosure was higher among participants diagnosed prior to current pregnancy (41% to their partners and 24% to family, friends or others) relative to those diagnosed during current pregnancy (21% to partners and 12% to family). About one‐quarter of women reported any type of IPV in the past 12 months. Disclosure to a partner was associated with lower depressive symptoms among women diagnosed prior to current pregnancy (MD −0.55; 95% CI: −1.06, −0.04) but the opposite was observed among those diagnosed during current pregnancy (MD 0.5; 95% CI: −0.4, 1.4). Adjustment for IPV, knowledge of partner''s status, age, number of living children and primigravidae did not change MDs substantially.ConclusionsWomen in our sample mostly disclosed to partners despite high IPV burden. The observed association between disclosure to partners and lower depressive symptoms among women diagnosed prior to current pregnancy is consistent with cross‐national evidence. A prospective study among pregnant WLHIV is needed to examine longitudinal effects of HIV status disclosure.     

Public Stigma of Mental Illness in the United States: A Systematic Literature Review

Public stigma is a pervasive barrier that prevents many individuals in the U.S. from engaging in mental health care. This systematic literature review aims to: (1) evaluate methods used to study the public’s stigma toward mental disorders, (2) summarize stigma findings focused on the public’s stigmatizing beliefs and actions and attitudes toward mental health treatment for children and adults with mental illness, and (3) draw recommendations for reducing stigma towards individuals with mental disorders and advance research in this area. Public stigma of mental illness in the U.S. was widespread. Findings can inform interventions to reduce the public’s stigma of mental illness.