Universal depression screening can improve viral suppression in PLWH, model suggests
Universally screening people living with HIV (PLWH) for depression and offering psychopharmacological treatment could increase viral suppression rates by 5% overall in the U.S., a new model simulation suggests. By addressing these unmet mental health needs, clinicians could improve both the health and quality of life in PLWH, the study authors assert.
About This Study
“Closing the gaps in the continuum of depression care for persons with HIV: Modeling the impact on viral suppression in the United States” was published online on March 6, 2023, in AIDS. The lead author is Linda J. Koenig, Ph.D., of the Division of HIV Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia.
Key Research Findings
Depression in PLWH is known to impact medication adherence, and thereby the likelihood of viral suppression. Study authors adapted the PATH 3.0 model to quantify the impact of an enhanced depression diagnosis and care scenario on viral suppression among PLWH, as compared to those who received a “status quo scenario.” In the enhanced scenario, every PLWH is assessed for depression, every person diagnosed is treated, and half of those treated keep their depression in remission.
The model simulation was for the period from 2016 to 2025. It assumed that the current standard of care results in 45% of depressed PLWH (who comprise 35% of all PLWH) being diagnosed, a little over half of those diagnosed being treated, and a third of those treated achieving remission of the mental health condition. The probability of being viremic was assumed to be 1.6 times greater in PLWH with depression than those without the condition.
Compared to the standard of care, the enhanced scenario increased viral suppression rates in PLWH with depression by 15% (11.5%-18.5%) over 10 years, resulting in 5% (3.4%-6%) more PLWH overall being virally suppressed compared to the standard of care. Beyond keeping HIV in check, depression treatment would also improve quality of life.
Discussion Highlights and Implications for Practice
The model’s enhanced scenario was based on current HIV care practices into which a brief screening tool could be incorporated. It quantified the expected outcome of psychopharmacological treatment but did not consider the potential benefits of non-pharmacological depression treatment, such as cognitive-behavioral therapy. The impact of untreated depression on PLWH falling out of care and not re-engaging was likewise not considered, study authors said.
Researchers also remarked that diversifying the mental health workforce might improve comfort levels with disclosing depressive symptoms, especially among Black PLWH. Furthermore, they stated that mental health services need to be available to patients—and covered by insurance—to have an impact on rates of depression (and, by extension, viral suppression) in PLWH.
By Barbara Jungwirth
Source : TheBodyPro