UNAIDS estimates that over 33 million people are currently living with the human immunodeficiency virus (HIV);2.5 million of these persons live in India and Southern India has among the highest HIV rates in the country. HIV-positive individuals suffer a host of co-morbidities that impact quality of life and disease progression, not the least of which is depression. Limited data are available on depression among HIV-positive persons in India, although small studies suggest the prevalence ranges from 20-47%, indicating it is likely to affect a large number of people. In addition to the psychosocial suffering that accompanies depressive mood disorders, depression has been associated with reduced adherence to antiretroviral therapy and increased sexual risk taking in some cases, although the evidence for the latter is mixed. Depression is also associated with poor biologic outcomes, including lower CD4 counts, higher viral load, more rapid disease progression and shortened survival. Screening for and treating depression therefore should be an integral part of HIV care services. Effective medications and psychotherapies for treating depression are available in urban centers in India where HIV care is delivered, but there is currently no system to screen and refer depressed HIV-positive individuals to trained mental health personnel. Therefore, we propose a series of studies designed to determine the feasibility of integrating a screening and referral system for depression into HIV care settings, with the following specific aims: (1) Compare 3 depression scales to psychiatric diagnoses of depression to identify the most appropriate tool to screen HIV-positive individuals in South India for depression;(2) Estimate the prevalence and correlates of depression among HIV- patients seeking care in an urban HIV clinic to identify modifiable factors;and (3) Identify barriers and facilitators to integrating depression screening into existing HIV-care services through focus groups and in-depth interviews.
Depression can result in significant psychosocial suffering and has been associated with numerous adverse outcomes among HIV-positive persons, including reduced adherence and poor biologic outcomes. Screening for and treating depression would contribute to primary HIV prevention by reducing viral load and thus transmission, and secondary prevention by reducing the psychosocial suffering and increasing quality of life among HIV-positive individuals in India.
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