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HIV/AIDS and Mental Health Integration : Is Something Not Right? Ilana Lapidos-Salaiz: MD, MPH Technical Leadership and Research Division Office of HIV/AIDS - USAID/Washington. - PowerPoint PPT Presentation
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HIV/AIDS and Mental Health Integration: Is Something Not
Right?
Ilana Lapidos-Salaiz: MD, MPHTechnical Leadership and Research Division
Office of HIV/AIDS - USAID/Washington
AIDS 2012 - Turning the Tide Together
ABOUT PEPFAR: Increase and build upon what works and, support countries as they work to improve the
health of their own people:
PEPFAR's Goals: • Transition from an emergency response to promotion of
sustainable country programs.• Strengthen partner government capacity to lead the
response to this epidemic and other health demands.• Expand prevention, care, and treatment in both
concentrated and generalized epidemics.• Integrate and coordinate HIV/AIDS programs with broader
global health and development programs to maximize impact on health systems.
• Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.
Evidence: Correlation between HIV and MH
Impact of MH on HIV• Mental illness may be a risk factor for HIV infection due
to impaired judgment and high risk behaviors (Collins, et al. 2006; Smit el al. 2006)
• Psychiatric disorders such as depression have been consistently linked with lowered likelihood of receiving HAART (Fairfield, et al, 1999)),
• Results in poorer medication adherence (Ammassari et al., 2002; Catz, Kelly, & Bogart,2000)
• if untreated, greater mortality” (Cook et al., 2004; Ickovics et al., 2001)
• “For HIV-infected people, mental illness is a risk factor for non-adherence to antiretroviral therapy (ART) (Mellins et al., 2003).
• Poor mental health undermines immune functioning and can negatively influence disease progression” (Antelman et al., 2007; Ickovics et al., 2001; Mellins et al., 2003; Murphy et al., 2004
• Successful treatment of depression improved adherence to ART (Dalessandro et al. 2007) and increases in CD4 counts (Horberg et al. 2008).
Impact of HIV on MH• Mental health conditions in PLHIV are under-
diagnosed and under-treated (WHO 2001)
• “PLWHA are twice as likely to suffer from depression than the general population (Ciesla & Roberts, 2001).
• “In all cohorts, ART was associated with reduced anxiety, depression, and dementia. In Cape Town, 85.5% of ART patients reported ‘‘no problems’’ with depression/anxiety after 12 months on ART, from 68.4% at baseline (Jelsma et al., 2005).
Continuum of care for PLHIVWHO continuum of care model proposes continuous and responsive support to PLHIV with input from different sources of formal and informal health care system…• Addressing Mental health* (and
psychosocial support) is a key element of the continuum of care model - a comprehensive care approach that should be addressed at all levels of care
• Advent of ART has resulted in PLHIV living “normal” active life but,
• PLHIV experience range of emotional, social, and spiritual needs throughout their life
WHO pyramid Framework for optimal mix of services
Elements necessary for integrating MH services
• Policy and guidelines• Incorporated into broader
Public Health Strategy to achieve maximum coverage and commitment
• Integrated into health care system – facility and community level
• Referral systems/networks: Linkage between facility and care linked to community on-going treatment
• Support for MH workers:• Human resource Development -
Community/Primary care training in screening and delivery of MH services
• Resources (including) funding• Drug supply and management
(adapted from Kelly and Freeman, 2005
Realities on the ground…• Policymakers, donors, health care leaders are burdened with
competing priorities • Goals targeting improved health must compete for policy attention and
resources • Difficult for countries to commit adequate resources to
comprehensively address mental health problems in that society, including PLHIV.
• Countries/programs are at different stages of implementation – challenge for transition to more sustainable, country-led and owned programs
• Program who are in less mature stages of system development are encouraged to learn from evidence base and use best practices to scale up services in efficient and effective manner
Gaps in MH services:Country profile of 9 countries (2010):
• Formulated mental health policy: 7 countries
• Formulated substance Abuse policy: 6 countries
• Formulated mental health program: 6 countries
• Adequate policy funding 2 out of 9 countries
• Access to services is varied:- Access to free essential
medication (Psychotropic drugs):
- Access to other basic services
Numbers of countries reporting national guidelines that address provision of psychological/mental health
services (N=25) Don’t know, 3
Yes, specific for
BOTH HIV- infected and
general population, 3
Yes, specific for HIV-infected, 5
No, 8
Yes, but not specific for HIV-
infected (general population), 6
Survey of 25 countries (2011):
Current USG efforts• Focused on increase screening
and interventions in community and primary care setting
• Integrate MH (depression and substance abuse) screening and treatment into HIV/AIDS (and other) services
• Strengthen linkage between other care and support services and mental health care (depression and alcohol abuse)
• Identify cost efficiencies and sustainable interventions
COP 2012: 36 countries reviewed
34 Psychosocial services
19 Mental health
10 depression programs
6 alcohol/substance abuse programs
Acknowledgments• USAID and PEPFAR• Coordinating Organizations (U.S. Health and Human Services Office of
Global affairs and U.S. National Institute of Mental)• Anne Herleth; Thomas Kresina (SAMHSA)
For further information on the HIV/AIDS Care and Support work that USAID does under the Care and Support portfolio, refer to: http://www.usaid.gov/our_work/global_health/aids/TechAreas/caresupport/index.html. You may also refer to PEPFAR’s care and support page: http://www.pepfar.gov/strategy/prevention_care_treatment/133360.htm.
For further information about presentation: ilapidossalaiz@usaid.gov
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