ABSTRACT

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remains a global public health challenge with profound physical, psychological, and social implications. Within West and Central Africa, Cameroon is among the countries with a high rate of HIV prevalence of 4.5%. With the advent of antiretroviral therapy (ART), there has been a significant improvement in the prognosis for individuals living with HIV. However, many patients still fail to adhere to their regimen. The objective of this study was to assess the relationship between mental state (e.g., depression, anxiety, post-traumatic stress disorder, suicidal thoughts and substance abuse) and adherence to ART among people living with HIV. Purposive sampling was employed to select the hospitals for the study, and questionnaires administered to study participants. Data was imported and analyzed in R version4.333. Chi-square test was used to check differences in the sociodemographic characteristics between groups, pearsons’ chi-square test to determine the prevalence of mental health awareness and disorders, and logistic linear regression to check the association between mental disorder and adherence to treatment. A p-value of <0.05 was considered statistically significant.There was a significant difference between some sociodemographic characteristics of the participants [gender, educational status and employment status (p <0.005)]. However, there was no significant difference between the ages of the participants, p= 3.805. An overall mental health awareness of 72.1% was recorded in both hospitals. Furthermore, mental prevalence in two hospitals was 9.58%. Depression, anxiety and posttraumatic stress disorder negatively affected ART adherence to treatment among participants. In conclusion, poor mental health negatively affected adherence to ART. This calls for intervention by health officials to mitigate the situation.

Keywords: Mental health, PLWH, ART, Treatment outcome, South West Region.

CHAPTER ONE

INTRODUCTION

1.1 Background

Human immunodeficiency virus (HIV), the causative agent of Acquired immunodeficiency syndrome (AIDS), has been around for many decades and yet remains a global public health challenge with profound physical, psychological, and social implications (UNAIDS, 2015). According to recent data from the World Health Organization (WHO), more than 39 million people worldwide were living with HIV in 2022, with over 1.5 million new infections occurring in 2021 alone (WHO, 2023). Although HIV/AIDS rates vary significantly between countries, it is important to note that the African continent bears a disproportionate share of the global HIV burden, accounting for nearly 70% of all people living with HIV (UNAIDS, 2021). Of great concern, sub-Saharan Africa remains the epicenter of the HIV epidemic, where the prevalence rate continues to be alarmingly high. Countries in North and West Africa, on the other hand, have significantly low prevalence rates. This might partially be explained by the fact that individuals within these populations typically engage in fewer high-risk cultural patterns that promote the spread of the virus in other parts of Africa (Mumtaz et al., 2021). Within West Africa, Cameroon is among the countries with high rates of HIV with a prevalence of 4.5% (PHIA, 2017). 

Thanks to breakthroughs in Antiretroviral Therapy (ART), there has been a significant improvement in the prognosis for individuals living with HIV (Labh and Gupta, 2021). Despite significant progress in scaling up ART, the Cameroon healthcare system still faces numerous challenges that impede the effective management and treatment of persons living with HIV. Since ART is a lifelong regimen, many patients still face the challenge of failing to adhere to their treatment due to several factors, such as distance to health centers, political instability, and social stigma (Okonji et al., 2020).

One critical, yet overlooked factor in the treatment of HIV is the mental health state of individuals living with the virus. Mental health issues such as depression, anxiety, and substance abuse, to name a few, are currently becoming more prevalent within the general population, especially among HIV patients and can potentially influence their adherence to ART (Okonji et al., 2020). A study on mapping the effectiveness of integrating mental health in HIV programmes supports that mental health negatively impacts health outcomes like engagement, retention in HIV care, and adherence to ART  (Conteh et al., 2023).  Therefore, understanding the impact of mental health state on HIV treatment outcomes is imperative for optimizing the care and well-being of people living with HIV, especially in areas with high prevalence such as the Southwest Region of Cameroon.