A recent article in Plos Medicines five part series on
global mental health makes for interesting reading. In it, the authors discuss
the benefits and challenges relating to integrating mental health care with
primary care for HIV patients in low to middle income countries. For healthcare
professionals aware of the robust evidence indicating that mental, neurological
and substance use disorders (also commonly known as MNS disorders) are nearly
twice as common among patients with HIV, this reading is hard to ignore.
When mental health co-morbidities
are related to an illness, it generally affects the patient’s quality of life
as the patient often changes his or her adherence to medications, increases
risk behaviour and alienates or gets alienated from social support. This in
turn, creates barriers in recovery and affects the sustainability of the
treatment. Although this is one of the most well documented clinical issues
within research, the ways of addressing it range between countries. The current
article suggests three key recommendations worth bearing in mind in order to
successfully address this issue for HIV patients across the world.
The first recommendation
advocates a life course approach whereby early initiation of HIV treatment is
to be prioritised. This is suggested to be due to the increased incidence of
static cognitive problems that are associated with prolonged periods of
elevated viral load. Addressing these cognitive difficulties early would have a
knock on effect on academic and vocational achievement.
The second recommendation urges
that psychological evidence based interventions are integrated into primary
care, whether it be through individual sessions or group sessions of cognitive
behavioural therapy, interpersonal therapy or problem-solving therapy. However,
the authors also discuss the challenges in diagnosing cognitive difficulties in
this population, as there currently is a lack of tools that are cross-culturally
validated and applicable to all age groups.
Lastly, the authors recommend
that their recommendations be translated into the specific cultural context
they are aimed at. Whilst it is easy to criticize what ought to be done, it is
important to understand the underlying factors, such as rescores and attitudes
towards mental health treatment, that can affect whether or not an intervention
gets accepted and carried out in the first instance.
Currently,
there is not sufficient evidence to assess how successful these recommendations
would be. However, on the face of it, it is difficult to deny their potential
usefulness for individuals that are already affected by these issues. If
successful, then the programmes could break certain barriers to treatment and
potentially prevent harm among some patients. They could help inform patients
about aspects of HIV that may not be discussed in all societies and thereby
engage rather than alienate vulnerable individuals.
The full report can be read here.