The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: A cohort study using linked electronic health records

Y. Ruffieux; O. Efthimiou; L. L. Van Den Heuvel; J. A. Joska; M. Cornell; S. Seedat; J. P. Mouton; H. Prozesky; C. Lund; N. Maxwell; M. Tlali; C. Orrell; M. A. Davies; G. Maartens; A. D. Haas

doi:10.1017/S2045796021000196

The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: A cohort study using linked electronic health records

Y. Ruffieux, O. Efthimiou, L. L. Van Den Heuvel, J. A. Joska, M. Cornell, S. Seedat, J. P. Mouton, H. Prozesky, C. Lund, N. Maxwell, M. Tlali, C. Orrell, M. A. Davies, G. Maartens, A. D. Haas^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

Abstract

Aims Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services. Methods We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression. Results In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes. Conclusions There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.

Original language	English
Article number	e37
Journal	Epidemiology and Psychiatric Sciences
DOIs	https://doi.org/10.1017/S2045796021000196
Publication status	Accepted/In press - 2021

Keywords

Mental health care
people living with HIV
South Africa
treatment gap

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1017/S2045796021000196

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Ruffieux, Y., Efthimiou, O., Van Den Heuvel, L. L., Joska, J. A., Cornell, M., Seedat, S., Mouton, J. P., Prozesky, H., Lund, C., Maxwell, N., Tlali, M., Orrell, C., Davies, M. A., Maartens, G., & Haas, A. D. (Accepted/In press). The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: A cohort study using linked electronic health records. Epidemiology and Psychiatric Sciences, Article e37. https://doi.org/10.1017/S2045796021000196

@article{d75e394a06ff4e6388382217397be238,

title = "The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: A cohort study using linked electronic health records",

abstract = "Aims Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services. Methods We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression. Results In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes. Conclusions There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.",

keywords = "Mental health care, people living with HIV, South Africa, treatment gap",

author = "Y. Ruffieux and O. Efthimiou and {Van Den Heuvel}, {L. L.} and Joska, {J. A.} and M. Cornell and S. Seedat and Mouton, {J. P.} and H. Prozesky and C. Lund and N. Maxwell and M. Tlali and C. Orrell and Davies, {M. A.} and G. Maartens and Haas, {A. D.}",

year = "2021",

doi = "10.1017/S2045796021000196",

language = "English",

journal = "Epidemiology and Psychiatric Sciences",

issn = "2045-7960",

publisher = "CAMBRIDGE UNIV PRESS",

}

Ruffieux, Y, Efthimiou, O, Van Den Heuvel, LL, Joska, JA, Cornell, M, Seedat, S, Mouton, JP, Prozesky, H, Lund, C, Maxwell, N, Tlali, M, Orrell, C, Davies, MA, Maartens, G & Haas, AD 2021, 'The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: A cohort study using linked electronic health records', Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796021000196

TY - JOUR

T1 - The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa

T2 - A cohort study using linked electronic health records

AU - Ruffieux, Y.

AU - Efthimiou, O.

AU - Van Den Heuvel, L. L.

AU - Joska, J. A.

AU - Cornell, M.

AU - Seedat, S.

AU - Mouton, J. P.

AU - Prozesky, H.

AU - Lund, C.

AU - Maxwell, N.

AU - Tlali, M.

AU - Orrell, C.

AU - Davies, M. A.

AU - Maartens, G.

AU - Haas, A. D.

PY - 2021

Y1 - 2021

N2 - Aims Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services. Methods We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression. Results In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes. Conclusions There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.

AB - Aims Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services. Methods We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression. Results In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes. Conclusions There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.

KW - Mental health care

KW - people living with HIV

KW - South Africa

KW - treatment gap

UR - http://www.scopus.com/inward/record.url?scp=85106191258&partnerID=8YFLogxK

U2 - 10.1017/S2045796021000196

DO - 10.1017/S2045796021000196

M3 - Article

C2 - 33993900

AN - SCOPUS:85106191258

SN - 2045-7960

JO - Epidemiology and Psychiatric Sciences

JF - Epidemiology and Psychiatric Sciences

M1 - e37

ER -

The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: A cohort study using linked electronic health records

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Keywords

UN SDGs

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