Integrating Depression Screening into HIV-care in Southern India.

说明（由申请人提供）：联合国艾滋病规划署估计，目前有3300多万人感染了人类免疫缺陷病毒（艾滋病毒）；其中250万人生活在印度，印度南部是该国艾滋病毒感染率最高的地区之一。艾滋病毒阳性个体患有许多影响生活质量和疾病进展的合并症，其中最重要的是抑郁症。关于印度艾滋病毒阳性者中抑郁症的数据有限，尽管小型研究表明患病率在20-47%之间，这表明它可能影响到很多人。除了伴随抑郁情绪障碍的心理社会痛苦之外，抑郁症还与抗逆转录病毒治疗依从性降低以及在某些情况下性风险增加有关，尽管后者的证据好坏参半。抑郁症还与不良的生物学结果相关，包括CD4计数较低、病毒载量较高、疾病进展更快和生存期缩短。因此，筛查和治疗抑郁症应成为艾滋病毒护理服务的一个组成部分。在印度提供艾滋病护理的城市中心，治疗抑郁症的有效药物和心理疗法是可用的，但目前没有系统筛选和将抑郁的艾滋病毒阳性个体转介给训练有素的精神卫生人员。因此，我们提出了一系列研究，旨在确定将抑郁症筛查和转诊系统整合到艾滋病毒护理环境中的可行性，其具体目的如下：(1)比较3种抑郁症量表与抑郁症的精神病学诊断，以确定筛查南印度艾滋病毒阳性个体抑郁症的最合适工具；(2)估计在城市HIV门诊就诊的HIV患者的抑郁患病率及其相关因素，以确定可改变的因素；(3)通过焦点小组和深度访谈，确定将抑郁症筛查纳入现有艾滋病毒护理服务的障碍和促进因素。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.