Mental health should be integrated into Kenya’s HIV management programs. The struggle for people living with HIV is multifaceted. Support with mental care is one way of plugging into a gaping gap.
The situation has been aggravated by the Covid-19 pandemic, according to Prof Kenneth Ngure in Nairobi. Prof Ngure is an Associate Professor and Chair of the Department of Community Health at the Jomo Kenyatta University of Agriculture and Technology (JKUAT) and heads the Public Health department at the Jomo Kenyatta. He is also an associate professor at Washington University. He was addressing participants during the closing of the Maisha 21 National HIV Conference. In his remarks, Prof Ngure warned the country against neglecting the growing incidence of mental health issues among people living with HIV, adding that doing so will derail its bid to achieve the 95-95-95 target set by UNAIDS.
The UNAIDS target envisions testing 95 per cent of those with HIV, putting 95 per cent of the testing on treatment and targeting 95 per cent of these for viral suppression through adherence to antiretroviral (ARV) drugs.
Prof Ngure, who is also Affiliate Associate Professor at the Department of Global Health at the University of Washington, USA, is rooting for mental health to become one of the key pillars of HIV-Aids management in the country.
“If we do not prioritize mental health programs, we will not be able to meet our 95-95-95 targets,” he said.
On her part, Prof Ruth Nduati of the University of Nairobi said that mental health care for caregivers of HIV-infected children should also be incorporated into the program.
She admitted that the caregivers receive some counselling during the testing and diagnosis of the children, but noted they need more attention to help the children adhere to medication and other lifestyle requirements.
“Around 65 percent of caregivers were found to have depression. Mental health services for caregivers are needed. There is some level of counselling offered to the caregivers at health facilities but the services are not well embedded in the Prevention of Mother to Child program,” said Prof Nduati.
Quoting findings from a 2020 study done by paediatrician Dr Agatha Kihio, Prof Nduati said the situation is worrying enough to warrant the rejigging of the care package to include mental health.
“If taken as prescribed, HIV medicine reduces the amount of HIV in the body (viral load) to a very low level, which keeps the immune system working and prevents illness. This is called viral suppression, which is defined as having less than 200 copies of HIV per milliliter of blood.
At this stage in treatment, the adults are unable to transmit HIV through their bodily fluids.
Speaking to Xinhua News Cabinet Adminstrative Secretary Dr Rashid Aman Aman said roughly a quarter or 25 percent of people visiting health care facilities have a mental disorder like anxiety, schizophrenia and depression but are sadly unaware of their condition.
Mental Health Amongst Caregivers
A 2012 study carried out at on 228 caregivers at Lea Toto Clinic in Kibra by Dr Alexander Wainaina and published in the University of Nairobi paints a dark portrait of the challenges caregivers must grapple with.
Study results showed that 147 or 65 per cent of the caregivers had depression.
What stood out was the reach of depression across the caregivers’ diverse age groups.
“The presence of depression had no significant relationship with the age of a caregiver, relationship to the child, duration of living with a HIV-infected child, disclosure of HIV status to the child, existence of the HIV-infected child’s parents, or the child’s age,” Dr Wainaina wrote.
Depression also cut a jagged edge between families.
“Caregivers of children who had only a mother as their living parent had the highest level of depression. Of all the caregivers, step parents had the highest levels of depression while non-relative male adults had the lowest levels,” Dr Wainaina revealed.
Prof Nduati said there is a link between depression and the children’s chances of achieving viral suppression.
What is non-adherence to ARV therapy?
Non-adherence to ARVs occurs when the client enrolled for treatment fails to take their medication at the required doses and times.
Prof Nduati sounded the alarm against what she termed “unplanned interruption” of ARVs, saying it posed the threat of treatment failure.
“Unplanned ARV interruption is risky for the person living with HIV. When you interrupt ARVs, you have a twofold increase in the risk of treatment failure after just 30 days. The risk rises to sixfold after 6 months,” said the lecturer and researcher.
She named drug stockouts, industrial action by health workers and lack of psychosocial support as contributing factors to non-adherence.
Aside from government intervention at facility level, Prof Ngure has identified community-based patient support as the key to overcoming depression among caregivers and ARV clients living with the virus.
“Community-led treatment approaches should include all stakeholders to achieve maximum success,” he says.