HIV Intervention/Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA)

Globally, 2.1 million children and adolescent have HIV, 80% of these are found in sub-Saharan Africa. Studies from developing countries have documented a considerable burden of impairing psychiatric disorders among children and adolescents with HIV. There is a lack of such research from sub-Saharan Africa where the biggest burden exists. Research in this area is required to inform the development of interventions and for advocacy with policy makers and implementers.

We undertook a longitudinal study to investigate psychiatric and neuropsychiatric disorders among 1,339 HIV positive children and adolescents and their caregivers in Uganda. This study involves assessments at baseline, 6-months and 12-months. We are in the process of completing the 12-months assessments (to be completed by the 30th June 2016). Retention in the study has been good, at 6-months was 1202 (90% retention rate), while at 12-months has so far been 1190 (88.9% retention; as of 13th June 2016).

From the baseline data, 433 (32.4%) had significant psychiatric symptomatology. About a quarter of the study respondents 314(23.5%) reported functional impairment as a results of psychiatric symptomatology. Therefore, HIV in childhood and adolescence in the sub-Saharan African context of Uganda is associated with a considerable burden of psychiatric symptomatology which is associated with considerable functional impairment.

Background: Globally, 2.1 million children and adolescent are living with HIV (CA-HIV), 80% of these are found in sub-Saharan Africa (UNAIDS, 2012). It is estimated that between 20-50% of CA-HIV have neuropsychiatric disorder which not only impairs their quality of life but also interferes with their social and academic functioning and predispose them to high risk behaviours. Most of the research in this area has been undertaken in high income countries with a lack of studies from sub-Saharan Africa where the biggest burden exists. The few African studies in this area have mostly been small and cross-sectional in nature hence not able to elucidate the complex inter-relationship between variables involved in these disorders.
Study design: We are currently undertaking a longitudinal study involving 1,339 CA-HIV and their caregivers enrolled from both urban and rural HIV clinics in central and south-western Uganda. This is a 12-months study with assessments at baseline, 6-months and 12-months and involves a qualitative component.
Objectives: The general objectives of this study to understand psychiatric disorders (PD) and neurocognitive disorder (NCD) among children and adolescents with HIV (CA-HIV) in Uganda. The specific objectives are: i) to determine the prevalence and incidence of PD and NCD among CA-HIV; ii) to determine the risk factors and predictors of PD and NCD among CA-HIV; iii) to describe the impact of PD on negative behavioural and clinical outcomes; iv) to investigate explanatory models of PD, help-seeking behaviour, unmet needs of care and expectations from mental health care services.
Updates so far: We are in the process of completing the 12-months assessments (to be completed by the 30th June 2016). Retention in the study has been good, at 6-months was 1202 (90% retention rate), while that at 12-months has so far been 1190 (88.9% retention; as of 13th June 2016).
Preliminary results: From the baseline data, 93 (7.0%) had at least one DSM-5 psychiatric disorder and 433 (32.4%) had above threshold psychiatric symptomatology. The main DSM-5 psychiatric disorders reported included: oppositional defiant disorder (ODD) 29(2.2%), separation anxiety disorder 25(1.9%), attention-deficit hyperactivity disorder (ADHD)16(1.2%), conduct disorder 16(1.2%), generalised anxiety disorder 10(0.8%) and major depressive disorder 7(0.5%). About a quarter of the study respondents 314(23.5%) reported functional impairment as a results of psychiatric symptomatology.
Conclusion: HIV in childhood and adolescence in the sub-Saharan African context of Uganda is associated with a considerable burden of psychiatric symptomatology which is associated with considerable functional impairment.