E Kinyanda, MRC/UVRI Uganda Research Unit on AIDS - Mental health among HIV infected CHildren and Adolescents in KAmpala, Uganda (CHAKA)

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HIV disproportionately affects children and adolescents in sub-Saharan Africa, where 90% of those infected reside. In Uganda, the country with the fifth highest prevalence rate in the region, more than 10% of the 1.2 million people living with HIV are under the age of 15. In addition to its physical impact, HIV infected children and adolescents (CA-HIV) report poor mental wellbeing. Epidemiological research from high-income countries has found high rates of psychiatric disorder (PD; e.g. depression, anxiety and behaviour disorders). Evidence on risk factors for PD in CA-HIV remains inconclusive. However, potential risk factors include: poor maternal health; HIV disease severity; caregiver PD; HIV related neurological/developmental disability; stigma, death in the family and negative environmental factors; pain; and genetic factors. Although sub-Saharan Africa shoulders the greatest burden of youth HIV, little research has been conducted to better understand psychiatric problems among CA-HIV in the region. The aim of this study is to investigate the impact of PD on CA-HIV in Uganda and the implications for service provision. The objectives of this study are to: (1) determine the prevalence, 12-month incidence and predictors of PD (including neurocognitive impairment) among CA-HIV; (2) investigate the relationship between differences in the serotonin transporter gene and depressive disorder; (3) examine the impact of PD on HIV disease progression; (4) examine the impact of PD on social and academic functioning and risky behaviours (i.e. treatment adherence, alcohol use, sexual behaviour and suicidal behaviour); and (5) investigate help-seeking behaviour and identify service delivery gaps in Ugandan HIV services. These objectives will be met through a cohort study of 1,260 CA-HIV and their caregivers from two paediatric HIV clinics in urban and rural Uganda. Socio-demographic characteristics and psychosocial, clinical, genetic and biological data will be collected by trained psychiatric research nurses and study clinicians at baseline and six and 12 month follow-up. Nested in the cohort, we will carry out a qualitative sub-study of 48 CA-HIV diagnosed with a psychiatric disorder (PD) and their caregivers to investigate explanatory models of PD help-seeking behaviour, unmet needs of care and expectations from mental health care services. Interviews will be conducted on two occasions, within two months of baseline assessment and at 12 month follow-up.HIV care services in Uganda are currently in the process of transitioning from a vertical care structure to one fully integrated into the formal health care system which focuses on the needs of people living with HIV/AIDS. The results of this timely study will provide policymakers and service providers with invaluable information to strengthen the provision of appropriate and effective mental health care for this vulnerable group.