Cargando…
Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda
BACKGROUND: Depression is rarely screened for among People Living with Human Immunodeficiency Virus (PLHIV) although it is 2 to 3 times more prevalent among PLHIV than in the general population. In instances where depression is screened for using screening tools, it usually follows noticing depressi...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242435/ https://www.ncbi.nlm.nih.gov/pubmed/35767586 http://dx.doi.org/10.1371/journal.pone.0270175 |
_version_ | 1784738056674213888 |
---|---|
author | Okimat, Paul Akena, Dickens Opio, Denis Mutabazi, Tobius Sendaula, Emmanuel Semitala, Fred C. Kalyango, Joan N. Karamagi, Charles A. |
author_facet | Okimat, Paul Akena, Dickens Opio, Denis Mutabazi, Tobius Sendaula, Emmanuel Semitala, Fred C. Kalyango, Joan N. Karamagi, Charles A. |
author_sort | Okimat, Paul |
collection | PubMed |
description | BACKGROUND: Depression is rarely screened for among People Living with Human Immunodeficiency Virus (PLHIV) although it is 2 to 3 times more prevalent among PLHIV than in the general population. In instances where depression is screened for using screening tools, it usually follows noticing depression risk factors. This practice of selectively screening for depression could be leaving some cases of depression unattended to. On the other hand, subjecting every client to screening tools (non-selective screening) offers every patient an opportunity to be managed for depression. However, this could require additional resources as compared to selective screening. We present and discuss results on whether non-selective and selective screening strategies differ in depression case detection, and in addition, we also present perceptions of the stake holders on the two screening strategies. METHODS: The study was conducted in Princess Diana Memorial Health Centre IV HIV clinic using a randomized controlled trial with a qualitative component. To determine whether there was a difference in depression case detection, consecutively sampled participants were randomly allocated to either non-selective or selective screening strategy. Participants allocated to selective screening were screened for depression using the patient health questionnaire (s) (PHQs) if they were at “crisis points”. While those allocated to non-selective screening were screened regardless of whether the “crisis points” were noticed or not. The PHQ-2 and PHQ-9 were used in sequence. 326 PLHIV participated in the study. Outcomes of the MINI evaluation were analyzed for those with PHQ-9 scores of 10 or more to confirm major depressive disorder (MDD). Data was analyzed using the two sample Z-test for proportions with Stata 2013 software. To explore the perceptions of the stake holders, key informant interviews were performed with six stakeholders that experienced the study. RESULTS: Cases of depression (PHQ-9 score ≥ 5) were more likely to be detected by the non-selective screening strategy 30.2% (49/162) compared to the selective screening strategy 19.5% (32/164) (difference in proportions 0.107, 95% confidence interval 0.014–0.200, Cohen’s h = 0.25, P = 0.03). The stake holders thought it was important to screen for depression among PLHIV with preference to non-selective screening strategy. CONCLUSION: Evidence from this data suggests that more cases of depression (PHQ-9 score ≥ 5) are likely to be detected with non-selective screening as opposed to selective screening. TRIAL REGISTRATION: PACTR201802003141213 (name: comparison of routine versus selective screening for depression strategies among PLHIV attending Princess Diana Memorial Health Centre iv Soroti). |
format | Online Article Text |
id | pubmed-9242435 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-92424352022-06-30 Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda Okimat, Paul Akena, Dickens Opio, Denis Mutabazi, Tobius Sendaula, Emmanuel Semitala, Fred C. Kalyango, Joan N. Karamagi, Charles A. PLoS One Research Article BACKGROUND: Depression is rarely screened for among People Living with Human Immunodeficiency Virus (PLHIV) although it is 2 to 3 times more prevalent among PLHIV than in the general population. In instances where depression is screened for using screening tools, it usually follows noticing depression risk factors. This practice of selectively screening for depression could be leaving some cases of depression unattended to. On the other hand, subjecting every client to screening tools (non-selective screening) offers every patient an opportunity to be managed for depression. However, this could require additional resources as compared to selective screening. We present and discuss results on whether non-selective and selective screening strategies differ in depression case detection, and in addition, we also present perceptions of the stake holders on the two screening strategies. METHODS: The study was conducted in Princess Diana Memorial Health Centre IV HIV clinic using a randomized controlled trial with a qualitative component. To determine whether there was a difference in depression case detection, consecutively sampled participants were randomly allocated to either non-selective or selective screening strategy. Participants allocated to selective screening were screened for depression using the patient health questionnaire (s) (PHQs) if they were at “crisis points”. While those allocated to non-selective screening were screened regardless of whether the “crisis points” were noticed or not. The PHQ-2 and PHQ-9 were used in sequence. 326 PLHIV participated in the study. Outcomes of the MINI evaluation were analyzed for those with PHQ-9 scores of 10 or more to confirm major depressive disorder (MDD). Data was analyzed using the two sample Z-test for proportions with Stata 2013 software. To explore the perceptions of the stake holders, key informant interviews were performed with six stakeholders that experienced the study. RESULTS: Cases of depression (PHQ-9 score ≥ 5) were more likely to be detected by the non-selective screening strategy 30.2% (49/162) compared to the selective screening strategy 19.5% (32/164) (difference in proportions 0.107, 95% confidence interval 0.014–0.200, Cohen’s h = 0.25, P = 0.03). The stake holders thought it was important to screen for depression among PLHIV with preference to non-selective screening strategy. CONCLUSION: Evidence from this data suggests that more cases of depression (PHQ-9 score ≥ 5) are likely to be detected with non-selective screening as opposed to selective screening. TRIAL REGISTRATION: PACTR201802003141213 (name: comparison of routine versus selective screening for depression strategies among PLHIV attending Princess Diana Memorial Health Centre iv Soroti). Public Library of Science 2022-06-29 /pmc/articles/PMC9242435/ /pubmed/35767586 http://dx.doi.org/10.1371/journal.pone.0270175 Text en © 2022 Okimat et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Okimat, Paul Akena, Dickens Opio, Denis Mutabazi, Tobius Sendaula, Emmanuel Semitala, Fred C. Kalyango, Joan N. Karamagi, Charles A. Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda |
title | Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda |
title_full | Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda |
title_fullStr | Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda |
title_full_unstemmed | Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda |
title_short | Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda |
title_sort | screening plhiv for depression using phqs: a rct comparing non-selective with selective screening strategy within a primary health care facility in uganda |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242435/ https://www.ncbi.nlm.nih.gov/pubmed/35767586 http://dx.doi.org/10.1371/journal.pone.0270175 |
work_keys_str_mv | AT okimatpaul screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT akenadickens screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT opiodenis screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT mutabazitobius screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT sendaulaemmanuel screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT semitalafredc screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT kalyangojoann screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda AT karamagicharlesa screeningplhivfordepressionusingphqsarctcomparingnonselectivewithselectivescreeningstrategywithinaprimaryhealthcarefacilityinuganda |