Psychological Distress Increases 30-Fold Among People with HIV in the First Year on ART in Nigeria—a Call for Integrated Mental Health Services

Abstract

Background: Few studies have longitudinally assessed psychological distress among people with HIV (PWH) initiating ART in resource-limited settings. Method: Baseline, 6-month, and 12-month psychological distress were measured in a Nigerian cohort newly initiating therapy; the relationship between baseline factors and psychological distress at 12 months was assessed; and the association between psychological distress at 12 months and care retention or immunologic failure was determined. Results: Among 563 patients, median age was 38 years (IQR: 33–46 years), 62% were female, and 51% were married. Psychological distress increased from 3% at baseline to 34% at 12 months. Age (aOR 1.28, 95% CI 1.06–1.56), female sex (aOR 2.89, 95% CI 1.93–4.33), lack of disclosure (aOR 4.32, 95% CI 2.48–7.51), and time on ART (6 months [aOR 6.91, 95% CI 3.14–15.18] and 12 months [aOR 32.63, 95% CI 16.54–64.36]) were associated with psychological distress while being married (OR 0.42, 95% CI 0.30–0.61) was associated with reduced odds. Tweve-month psychological distress was associated with increased risk of immunologic failure (aOR 2.22, 95% CI 1.31–3.82). Conclusion: The risk of psychological distress increased 30-fold in the first year on therapy in PWH in Nigeria.