RESEARCH PROPOSAL

1. RESEARCH PROPOSAL Dr Nita M Besa Mmed Psychiatry 2nd year University Of Zambia 2012

2. TITLE Prevalence and correlates of psychiatric disorders in an HIV positive Urban population in Zambia

3. Background • Psychiatric disorders occur frequently in HIV disease (Treisman et al,2002), affecting up to half of these patients

4. Background Etiology of psychiatric disorders Chandra et al,2005 • Psychiatric disorders, a risk factor for HIV infection • Psychological reactions from being HIV positive • Direct neuro-pathological effect of virus on brain • Opportunistic Infections • Medications

5. Background Implications of Psychiatric diagnoses in HIV • Vector for HIV transmission (Hartzell et al,2008) • Decrease quality of life • Affect (Antelman et al,2007) and could be markers (Hutchinson et al,2005) of HIV disease progression • Adherence to drugs ( Gordillo et al,1999) • Ability to cope with standard procedures of HIV care (Holzemer et al,1999) • However, most go unnoticed & untreated

6. Background • Prevalence estimates have varied, generally ranging from 2 – 48%. • Some studies have had higher estimates-82.6% (Ovuga et al, 2005) • Many have used screening instruments which may overestimate actual prevalence

7. Background • Predictors of psychiatric disorders have varied • Clinical stage (Adewuya et al 2007) and lower economic status/income • No association with clinical stage, but unemployment, living alone & work related disabilities • Young age(Myer L et al,2008)

8. Background • The burden of HIV in Zambia is high • At the end of 2009, prevalence of HIV in Zambia estimated to be 14.3% ranking it seventh among countries most affected (Zambia UNGASS, 2010) • Results from a Zambian study suggested that HIV infection has a substantial influence on mental distress (Chipimo et al, 2009)

9. Study Justification • The prevalence of HIV in Zambia is high • Prevalence of psychiatric disorders in HIV population in Zambia is not known • Knowledge of the local burden will help in policy and planning purposes • Knowledge of the local correlates will alert physicians to identify susceptible individuals who may require further evaluation

10. Objectives Main Objective • To determine the prevalence and co-relates of psychiatric disorders in HIV positive patients attending an HIV clinic at Chilenje Health centre in Lusaka, Zambia.

11. Specific Objectives • To determine the prevalence of psychiatric disorders in HIV positive patients • To examine demographic, psychosocial and clinical correlates in HIV patients who present with psychiatric disorders • To describe implications of psychiatric disorders in HIV

12. Methodology Study Design • Cross sectional study Site • Chilenje Health centre- a primary health facility, located south east of the city centre

13. Methodology Sample size • Based on expected 48% prevalence of psychiatric disorders in HIV patients, I will need 370 patients at precision of +/-5% and 95% confidence interval Sampling • Systematic sampling

14. Methodology Study Procedure and Tools The following tools will be used: • The Mini International Neuropsychiatric Interview for psychiatric diagnosis. • Astandardized demographic questionnaire, • Multi dimensional social support scale • The HIV treatment adherence self efficacy scale

15. Methodology Study Procedure and Tools • General physical examination • Blood sample collection on the spot • Brain Imaging

16. Methodology Dependant Variables • Psychiatric diagnoses

17. Independent Variables Demographic Clinical • Age • Gender • Marital status • Education level • Occupation • Income status Psycho-social • Social support • Number of sexual partners • Adherence to ART • Median time since HIV diagnosis • CD4 count • Viral load • Duration of ART use • Opportunistic infections • WHO clinical stage • CRP Methodology

18. Methodology Data Collection and Analysis • By Epi info software package • Logistic regression models will be used to evaluate demographic, psychosocial and clinical factors that will correlate with psychiatric diagnoses.

19. Ethical considerations • Approval by the University of Zambia Research and Ethics Committee will be sought. • Informed consent will be sought from the participants • Numbers will be assigned for the purpose of confidentiality. • Patients diagnosed with psychiatric disorders will be referred appropriately

20. Study Limitations • Cross sectional study • Causal relationships difficult to establish • Generalization of findings to other ART programs

21. Future Prospects • Case control study • Prevalence in different stages of HIV disease

22. Acknowledgements • Dr Gil Blackwood, Honorary Lecture Department of Psychiatry, University of Zambia • Dr Ravi Paul, Consultant/Lecturer, University of Zambia

23. References • Glenn Treisman ,‘ The infectious disease specialist and the Psychiatrist: Understanding the psychiatric issues in the treatment of HIV infected patients’ Advanced studies in medicine, May 2002 vol.2 No 6 • Chandra P ‘HIV and psychiatric disorders,’ Indian J Med Res 121 April 2005,ppv451-467 • Hartzel J. ‘ Impact of depression on HIV outcomes in the HAART era,’ Journal of Anti-microbial Chemotherapy (2008) 62;256-255 • Antelman G. ‘ Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania,’ J Acqui Immune DeficSyndr (2007) 44; 470-472 • Hutchinson G ‘Hiv mania as a marker for clinical deterioration in AIDS,’ West Indian Med J 2005; 54(2) 149 • Holzemer W. ‘Predictors of self reported adherence in persons living with HIV disease,’ AIDS Patient Care and STDs vol 13 Num 3, 1999 • Ovuga E. ‘Psychiatric disorders in HIV positive individuals in urban Uganda,’ The Psychiatrist (2005)29; 455-458 • UNGASS Zambia UNGASS country progress report on HIV and AIDS, March 2010 • Chipimo P. ‘Mental distress in the general population in Zambia: Impact of HIV and social factors,’ BMC public health (2009) 9: 298