Background
Methods
Study design and setting
Study participants and recruitment
Young people living with HIV
Young people without HIV
Sample size calculations
Measures
Interviewer-administered measures via android tablets
Measures administered via audio computer-assisted self-interview (ACASI)
Cross-cultural adaptation of study measures
Statistical analysis
Summary of data by participant group
Analysis of prevalence data
Analysis of risk and protective indicators for CMDs
Results
Overall sample characteristics
Characteristic | Total sample n = 812 | HIV status | ||
---|---|---|---|---|
HIV uninfected youths, n = 406 | HIV infected youths, n = 406 | p-value# | ||
Study sites | ||||
Kilifi | 403 (49.6) | 200 (49.3) | 203 (50.0) | 0.83 |
Mombasa | 409 (50.4) | 206 (50.7) | 203 (50.0) | |
Age -years, mean (SD) | 20.9 (2.1) | 21.0 (1.9) | 20.8 (2.2) | 0.13 |
Sex | ||||
Male | 400 (49.3) | 224 (55.2) | 176 (43.4) | < 0.01 |
Female | 412 (50.7) | 182 (44.8) | 230 (56.7) | |
Marital status, OM = 2 | ||||
Never married | 670 (82.7) | 358 (88.6) | 312 (76.9) | < 0.01 |
Separated/Divorced/Widowed | 32 (4.0) | 8 (2.0) | 24 (5.9) | |
Married/cohabiting | 108 (13.3) | 38 (9.4) | 70 (17.2) | |
Education level | ||||
Tertiary | 193 (23.8) | 130 (32.0) | 63 (15.5) | < 0.01† |
Secondary | 354 (43.6) | 179 (44.1) | 175 (43.1) | |
Primary | 253 (31.2) | 93 (22.9) | 160 (39.4) | |
None | 12 (1.5) | 4 (1.0) | 8 (2.0) | |
Employment | ||||
Formally employed | 27 (3.3) | 11 (2.7) | 16 (3.9) | 0.16 |
Self-employed | 94 (11.6) | 52 (12.8) | 42 (10.3) | |
Student | 303 (37.3) | 162 (39.9) | 141 (34.7) | |
Unemployed | 388 (47.8) | 181 (44.6) | 207 (51.0) | |
Parental loss | ||||
Both parents alive | 429 (52.8) | 308 (75.9) | 121 (29.8) | < 0.01 |
One parent alive | 238 (29.3) | 85 (20.9) | 153 (37.7) | |
Both parents died | 145 (17.9) | 13 (3.2) | 132 (32.5) | |
Living arrangement | ||||
Family/Relative | 720 (88.7) | 359 (88.4) | 361 (88.9) | 0.91 |
Friend/non-relative | 17 (2.1) | 8 (2.0) | 9 (2.2) | |
Alone | 75 (9.2) | 39 (9.6) | 36 (8.9) | |
Negative life events | ||||
None | 80 (9.9) | 51 (12.6) | 29 (7.1) | < 0.01 |
1–5 events | 476 (58.6) | 255 (62.8) | 221 (54.4) | |
6+ events | 256 (31.5) | 100 (24.6) | 156 (38.4) | |
Asset index score a – mean (SD) | 2.4 (1.6) | 2.6 (1.6) | 2.2 (1.6) | < 0.01 |
Social support score b – mean (SD) | 71.6 (8.7) | 72.1 (7.8) | 71.1 (9.5) | 0.09 |
Quality of life score c – mean (SD) | 78.8 (15.3) | 82.7 (12.0) | 74.8 (17.2) | < 0.01 |
HIV-related clinical and psychosocial characteristics of YLWH
Characteristic | Mean/Frequency | SD/percent |
---|---|---|
Recent Body Mass Index – kg/m2, mean, SD | 20.6 | 3.6 |
Any current chronic illness | ||
No | 399 | 98.3 |
Yes † | 7 | 1.7 |
cART regimen | ||
First line | 330 | 81.3 |
Second line 1 | 76 | 18.7 |
Viral load | ||
≤ 1000 copies/mL | 280 | 69.0 |
> 1000 copies/mL | 126 | 31.0 |
WHO clinical stage, OM = 1 | ||
Stage 1 | 249 | 61.5 |
Stage 2 | 102 | 25.2 |
Stage 3 | 52 | 12.8 |
Stage 4 | 2 | 0.5 |
Duration on cART | ||
> 5 years | 235 | 57.9 |
1–5 years | 124 | 30.5 |
6-11 months | 25 | 6.2 |
< 6 months | 22 | 5.4 |
Any current opportunistic infection | ||
No | 381 | 93.8 |
Yes | 25 | 6.2 |
Any cART side effects, OM = 1 | ||
No | 296 | 73.1 |
Yes | 109 | 26.9 |
Perceived HIV-stigma score a – mean, SD | 26.1 | 7.5 |
Medication (cART) adherence | ||
High adherence | 254 | 62.6 |
Medium adherence | 117 | 28.8 |
Low adherence | 35 | 8.6 |
HIV status disclosure | ||
Yes | 381 | 93.8 |
No | 25 | 6.2 |
Clinic accessibility | ||
Easily accessible (Less than 30 min) | 129 | 31.8 |
Somehow accessible (30 min to 1 h) | 175 | 43.1 |
Not accessible (> 1 h) | 102 | 25.1 |
Satisfaction with current care | ||
Satisfied | 383 | 94.3 |
Neutral | 16 | 3.9 |
Not satisfied | 7 | 1.7 |
Prevalence of common mental disorders
HIV uninfected youths, n = 406 | HIV infected youths, n = 406 | p-value | |||
---|---|---|---|---|---|
Frequency | Prevalence (95% CI) | Frequency | Prevalence (95% CI) | ||
Severity of depressive symptoms | |||||
Mild | 86 | 21.2 (17.5, 25.4) | 130 | 32.0 (27.6, 36.7) | < 0.001† |
Moderate | 34 | 8.4 (6.0, 11.5) | 78 | 19.2 (15.7, 23.4) | |
Moderately severe | 12 | 3.0 (1.7, 5.1) | 30 | 7.4 (5.2, 10.4) | |
Severe | 3 | 0.7 (0.2, 2.3) | 9 | 2.2 (1.2, 4.2) | |
Positive depression screen (cut-off score ≥ 10) | |||||
Yes | 49 | 12.1 (9.2, 15.6) | 117 | 28.8 (24.6, 33.4) | < 0.001# |
Severity of GAD symptoms | |||||
Mild | 98 | 24.1 (20.2, 28.6) | 138 | 34.0 (29.5, 38.8) | < 0.001 |
Moderate | 20 | 4.9 (3.2, 7.5) | 54 | 13.3 (10.3, 17.0) | |
Severe | 11 | 2.7 (1.5, 4.8) | 23 | 5.7 (3.8, 8.4) | |
Positive GAD screen (cut-off score ≥ 10) | |||||
Yes | 31 | 7.6 (5.4, 10.7) | 77 | 19.0 (15.4, 23.1) | < 0.001# |
Positive screen for comorbid depressive and GAD symptoms | |||||
Yes | 19 | 4.7 (3.0, 7.2) | 65 | 16.0 (12.7, 19.9) | < 0.001# |
Association between HIV status and common mental disorders
Positive screen for depressivesymptoms | Positive screen for GAD symptoms | Positive CMD comorbidity a | ||||
---|---|---|---|---|---|---|
Covariate | Crude analysis OR (95% CI) | Adjustedanalysisb aOR (95% CI) | Crude analysis OR (95% CI) | Adjustedanalysisb aOR (95% CI) | Crude analysis OR (95% CI) | Adjustedanalysisb aOR (95% CI) |
HIV status | ||||||
Negative | Ref | Ref | Ref | Ref | Ref | Ref |
Positive | 2.95** (2.04, 4.26) | 1.77* (1.13, 2.79) | 2.83** (1.82, 4.41) | 1.51 (0.88, 2.58 | 3.88** (2.28, 6.61) | 2.07* (1.11, 3.88) |
Sex | ||||||
Male | Ref | Ref | Ref | |||
Female | 1.41 (0.95, 2.09) | 1.70* (1.06, 2.72) | 2.16* (1.26, 3.70) | |||
Education | ||||||
Secondary | Ref | Ref | Ref | |||
Tertiary | 1.16 (0.68, 1.97) | 1.56 (0.84, 2.91) | 1.77 (0.88, 3.56) | |||
Primary | 1.77* (1.13, 2.76) | 1.67 (0.98, 2.83) | 2.12* (1.17, 3.84) | |||
None | 2.20 (0.52, 9.27) | 2.33 (0.49, 11.04) | 0.78 (0.08, 7.31) | |||
Employment | ||||||
Student | Ref | Ref | Ref | |||
Self-employed | 0.68 (0.33, 1.38) | 1.24 (0.55, 2.79) | 0.62 (0.23, 1.67) | |||
Formally employed | 1.10 (0.40, 3.00) | 1.95 (0.65, 5.80) | 1.59 (0.50, 5.13) | |||
Unemployed | 1.14 (0.73, 1.80) | 1.45 (0.83, 2.54) | 1.12 (0.61, 2.06) | |||
Parental loss | ||||||
Both parents alive | Ref | Ref | Ref | |||
One parent alive | 1.32 (0.83, 2.09) | 1.83* (1.06, 3.15) | 1.83 (0.99, 3.39) | |||
Both parents died | 1.80* (1.06, 3.06) | 2.40* (1.30, 4.44) | 2.26* (1.15, 4.45) | |||
Negative life events | ||||||
Nonec | 0.20* (0.05, 0.87) | 1.00 | 1.00 | |||
1–5 events | Ref | Ref | Ref | |||
6+ events | 4.26** (2.89, 6.27) | 4.00** (2.54, 6.31) | 3.80** (2.28, 6.35) | |||
n of the final model | 812 | 732 | 732 | |||
Hosmer-LemeshowTest | X2 = 218.73; p = 0.26 | X2 = 168.42; p = 0.48 | X2 = 170.68; p = 0.43 | |||
Variance explained | 17.1% | 15.0% | 16.7% |
Risk and protective indicators of common mental disorders in YLWH
Positive screen for depressive symptoms | Positive screen for GAD symptoms | Positive CMD Comorbiditya | ||||
---|---|---|---|---|---|---|
Covariate | Univariate analysis OR (95% CI) | Multivariable analysis aOR (95% CI) | Univariate analysis OR (95% CI) | Multivariable analysis aOR (95% CI) | Univariate analysis OR (95% CI) | Multivariable analysis aOR (95% CI) |
A priori: | ||||||
Age | 1.12** (1.02, 1.24) | 1.02 (0.91, 1.15) | 1.09* (0.97, 1.22) | 1.01 (0.88, 1.16) | 1.14** (1.01, 1.29) | 1.06 (0.92, 1.23) |
Sex | ||||||
Male | Ref | Ref | Ref | Ref | Ref | Ref |
Female | 1.62** (1.04, 2.53) | 1.08 (0.63, 1.84) | 2.04*** (1.20, 3.48) | 1.41 (0.74, 2.66) | 2.07** (1.16, 3.67) | 1.45 (0.73, 2.85) |
Demographic: | ||||||
Education level | ||||||
Secondary | Ref | – | Ref | – | Ref | – |
Tertiary | 1.25 (0.65, 2.41) | – | 1.41 (0.66, 3.01) | – | 1.74* (0.78, 3.89) | – |
Primary | 1.87** (1.16, 3.01) | – | 1.87** (1.07, 3.27) | – | 2.22** (1.21, 4.07) | – |
None | 2.03 (0.46, 8.84) | – | 2.00 (0.38, 10.47) | – | 1.17 (0.14, 10.06) | – |
Employment | ||||||
Student | Ref | – | Ref | – | Ref | – |
Self-employed | 0.71 (0.29, 1.75) | – | 0.99 (0.34, 2.85) | – | 0.77 (0.24, 2.42) | – |
Formally employed | 1.61 (0.52, 4.99) | – | 3.32* (1.03, 10.71) | – | 2.43 (0.70, 8.40) | – |
Unemployed | 1.97*** (1.21, 3.22) | – | 2.32*** (1.28, 4.23) | – | 1.75* (0.95, 3.23) | – |
Living arrangement | ||||||
Family/Relative | – | – | Ref | – | Ref | – |
Friend/non-relative | – | – | 0.58 (0.07, 4.72) | – | 0.73 (0.09, 5.93) | – |
Alone | – | – | 2.32** (1.10, 4.88) | – | 2.56** (1.19, 5.50) | – |
Psychosocial: | ||||||
Parental loss | – | – | – | |||
Both parents alive | Ref | – | Ref | – | Ref | – |
One parent alive | 1.41 (0.81, 2.44) | – | 2.03* (1.01, 4.08) | – | 1.86* (0.90, 3.86) | – |
Both parents died | 1.86** (1.07, 3.25) | – | 2.88*** (1.44, 5.78) | – | 2.34** (1.12, 4.85) | – |
Negative life events | ||||||
Noneb | 0.16* (0.02, 1.22) | 0.26 (0.03, 2.02) | 1.00 | – | 1.00 | – |
1–5 events | Ref | Ref | Ref | – | Ref | – |
6+ events | 4.30*** (2.70, 6.84) | 2.53*** (1.50, 4.26) | 3.64*** (2.15, 6.18) | – | 3.44*** (1.96, 6.05) | – |
Asset index | – | – | 0.81** (0.68, 0.95) | – | 0.76*** (0.63, 0.92) | – |
Social support | 0.94*** (0.92, 0.96) | 0.96*** (0.93, 0.98) | 0.93*** (0.91, 0.96) | 0.95*** (0.92, 0.98) | 0.92*** (0.89, 0.95) | 0.94*** (0.91, 0.97) |
Health-related quality of life | 0.95*** (0.93, 0.96) | 0.96*** (0.95, 0.98) | 0.94*** (0.93, 0.96) | 0.96*** (0.94, 0.97) | 0.95*** (0.93, 0.96) | 0.96*** (0.94, 0.98) |
Medication adherence | ||||||
High adherence | Ref | – | Ref | Ref | Ref | Ref |
Medium adherence | 2.18*** (1.35, 3.52) | – | 2.01** (1.14, 3.53) | 1.58 (0.82, 3.04) | 2.08** (1.15, 3.78) | 1.76 (0.88, 3.52) |
Low adherence | 3.83*** (1.85, 7.93) | – | 6.32*** (2.97, 13.49) | 2.97** (1.27, 6.95) | 4.77*** (2.16, 10.51) | 2.49** (1.02, 6.06) |
Perceived HIV-stigma | 1.10*** (1.06, 1.13) | 1.04** (1.01, 1.08) | 1.13*** (1.09, 1.17) | 1.09*** (1.04, 1.14) | 1.12*** (1.07, 1.16) | 1.07*** (1.02, 1.12) |
Clinical: | ||||||
Body Mass Index | – | – | 1.05* (0.99, 1.12) | – | – | – |
Viral load | ||||||
≤ 1000 copies/mL | Ref | – | – | – | – | – |
> 1000 copies/mL | 1.44* (0.92, 2.27) | – | – | – | – | – |
Duration on cART | ||||||
> 5 years | Ref | – | – | – | – | – |
1–5 years | 1.07 (0.66, 1.75) | – | – | – | – | – |
6-11 months | 1.54 (0.65, 3.65) | – | – | – | – | – |
< 6 months | 2.28* (0.94, 5.53) | – | – | – | – | – |
cART side effects | ||||||
No | Ref | – | – | – | – | – |
Yes | 1.75** (1.09, 2.78) | – | – | – | – | – |
n for the final model | 406 | 406 | 406 | |||
Variance explained | 22.3% | 26.2% | 25.0% | |||
Hosmer-Lemeshow test | X2 = 380.22; p-value = 0.73 | X2 = 437.56; p-value = 0.08 | X2 = 402.55; p-value = 0.43 | |||
cvMean AUC (95% CI) | 0.78 (0.69, 0.81) | 0.81 (0.77, 0.88) | 0.81 (0.74, 0.86) |