Integrating Mental Health Care with HIV and AIDS Care at Mildmay Uganda

Background: The prevalence of psychiatric comorbidities like depression, alcoholism, psychotic and cognitive disorders in persons living with HIV is relatively high in Sub Saharan Africa. Untreated mental disorders can lead to poor adherence to treatment and poor quality of life for patients with chronic diseases. Currently, Mildmay which has treated HIV positive clients since 1998 cares for 12000 HIV positive clients at its main site. In 2009, Mildmay Uganda Integrated mental health services into HIV care to close the treatment gap and ensuring that psychiatric eligible people get the mental health care that they need. The clinic is run every Tuesday and is managed by a visiting psychiatrist with support of Mildmay Uganda clinicians’ team. We report the prevalence of mental health conditions among HIV positive clients in care at Mildmay Uganda.

Methods: Mildmay clients are consented to both care and subsequent use of their data for retrospective researches. A retrospective analysis of existing data was conducted on all the Mildmay Uganda 12,000 clients active in care. This study reviewed client’s electronic data base, and identified mental health clients enrolled from January 2009 to June 2014. Data was cleaned and analyzed using SPSS version 21.

Results: The clients ever diagnosed with mental conditions were 2236 indicating a prevalence of 18.6% of the 12000 clients in care.  The common mental health conditions included depression (42.7%), bipolar disorders (16.9 %), psychosis (13.8 %) and alcoholism (5.5 %), epilepsy (10.3%) and other conditions like fits, lack of social care and academic stress (10.9%). Of the 2236 clients, 803 (35.9%) were males, while 1433 (64.1%) are females. The mean age was 33.5 years, with 89 (4%) aged below 4 years, 344 (15.4%) 10 -17, 465 (20.8%) 18 – 30, 526 (23.5%) 31 - 40, 551 (24.6%) 41-50, 259 (11.6%) 51 years.  All clients had their CD4 test done in their last visits, with a mean CD4 result of 400.1 cells, specific results include; less than 50cells 135 (6%), 50 – 250 cells 791 (35.4%), 251 – 500 cells 718 (32.1%), more than 500 cells 591 (26.4%). Majority (84%) of the clients diagnosed with these conditions were on ART while 342 (15.3%) had not yet started taking ART. The analysis indicated further a death rate of 3.8% (61% females and 38.8% males of the clients diagnosed with mental health conditions.

Conclusions: Psychiatric conditions are a growing public health problem among all age groups. Integrating mental health services into HIV care care is the most viable way of closing the treatment gap for those with mental health conditions.