Abstract:
Background: Psychiatric disorders and Human Immunodeficiency Virus (HIV) have been
closely interlinked with a causal relationship having been demonstrated. Among children,
mental disorders are a significant public health concern due to the rising prevalence. The
effects of HIV and mental disorders are pervasive and have far reaching implications that
impact on communities not only psychologically but also economically and socially.
However, little is known about the prevalence of mental disorders among
children/adolescents with HIV-infection and no studies have been done on the integration
of mental health services in HIV programs in our setting. This will be the first study in our
setting to give a baseline of prevalence of psychiatric disorders among children and
adolescents living with HIV while assessing the integration of mental health services in the
HIV program.
Objective: This study investigated the prevalence, patterns and factors associated with
psychiatric morbidity, while assessing models of mental health care of HIV-infected
children and adolescents between 6 and 17 years of age at Moi Teaching and Referral
Hospital (MTRH).
Methods: This was a descriptive cross-sectional study. Systematic sampling was applied
for children and adolescent group while a census was done for health workers group. Mini
Neuropsychiatric Interview for children and adolescents (MINI Kid) was used for
measuring psychiatric morbidity among children and adolescents with HIV infection.
Researcher designed questionnaires were used to obtain sociodemographic data, clinical
information and assess the models of mental health care. The study was carried out at
MTRH - Academic Model Providing Access to Healthcare (AMPATH)
Paediatric/Adolescent HIV clinics. Approval to conduct the study was given by
Institutional Research and Ethics Committee. A total of 391 children/adolescents with HIV
infection and 18 health workers at the AMPATH Paediatric/Adolescent HIV clinics were
interviewed. Descriptive statistics were used to explore the data while Chi-square test,
Fishers exact test and logistic regression were used to assess associations. Associations with
p value less than 0.05 were considered statistically significant.
Results The median age of the children/adolescents was 13 years (Interquartile range 11 -
15 years) with a female to male ratio of 1:1. The prevalence of psychiatric morbidity among
children/adolescents with HIV infection was 57.5%. The most prevalent disorders were
Anxiety 53.8%, Suicidality 10.4% and Attention Deficit Hyperactivity Disorder 10%. Only
1.7 % of those who screened positive for psychiatric disorders had ever been diagnosed or
received treatment. Compared to those less than 12 years, children older than 12 years had
36.3% reduced odds of having anxiety (O.R=0.637 C.I [0.425 - 0.953]; p value=0.028).
Majority of the health workers were nurses and clinical officers and half of them were
below 35 years of age. Only 38.9% of them had any mental health training. Mental health
services available at the clinics were psychological counselling, group therapy and review
by a psychiatrist once a week. There was ongoing screening for mental disorders and
referral to appropriate mental health services.
Conclusion There was a high prevalence of psychiatric disorders among
children/adolescents with HIV infection. Most of the disorders were undiagnosed and
therefore not treated despite there being mental health services at the AMPATH
Pediatrics/Adolescent HIV clinics.
Recommendations Due to the high prevalence, screening for psychiatric disorders should
be enhanced at the AMPATH Paediatric/Adolescent HIV clinics. Secondly, health care
providers should have regular training on basic mental health care. Finally, further research
needs to be done to determine the barriers to access and uptake of mental health services at
the AMPATH Paediatric/Adolescent HIV clinics.