Undetected psychiatric morbidity among HIV/AIDS patients attending Comprehensive Care Clinic (CCC) in Nairobi Kenya: towards an integrated mental health care.

Background: Psychiatric morbidity is commonly associated with HIV disease and may have adverse effects. This aspect may be overlooked at comprehensive HIV care centers in Low and Middle-Income Countries.

Objectives: The aim of this study was to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre in a semi-urban clinic, in Nairobi, Kenya.

Design: Descriptive cross-sectional study of adult HIV patients not receiving any psychiatric treatment was conducted.

Participants/methods: The participants consisted of consecutive sample of adults ( n  = 245) attending HIV Comprehensive Care Clinic at Kangemi Health Centre, Nairobi. The Mini International Neuropsychiatric Interview (MINI) was administered to screen for undetected psychiatric morbidity. Socio-demographic characteristics were recorded in a questionnaire. Sample descriptive analysis was performed and prevalence of undetected psychiatric morbidity calculated. Chi-square test for independence was used to examine the associations between patient characteristics and undetected morbidity. Multivariable logistic regression analysis was performed to determine independent predictors of undetected psychiatric morbidity.

Results: The mean age of our participants was 37.3 years (SD 9.2) Three-quarters (75.9%) of participants were females and median duration of HIV illness was 5 years. The prevalence of (previously undetected) psychiatric morbidity was 71.4% (95% CI 65.3-77). The leading psychiatric disorders were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). Overall psychiatric morbidity was associated with low income (<USD 30), p  = 0.035. MDD was associated with older age and female gender. There were no statistically significant associations between overall psychiatric morbidity and social determinants such as gender, marital status, level of education, religious affiliation, and occupation or employment status.

Conclusion: The burden of psychiatric morbidity in Kenyan HIV patients remains high and is most significantly associated with lower socioeconomic status. There is need to provide holistic care including screening for mental well-being all through the treatment of HIV patients in low-income settings.