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RESEARCH PROPOSAL
Dr Nita M Besa
Mmed Psychiatry 2nd year
University Of Zambia
2012
TITLE
Prevalence and correlates of
psychiatric disorders in an HIV
positive Urban population in Zambia
Background

Psychiatric disorders occur frequently in
HIV disease (Treisman et al,2002),
affecting up to half of these patients
Background
Etiology of psychiatric disorders
Chandra et al,2005
 Psychiatric disorders, a risk factor for HIV
infection
 Psychological reactions from being HIV
positive
 Direct neuro-pathological effect of virus on
brain
 Opportunistic Infections
 Medications
Background
Implications of Psychiatric diagnoses in HIV
 Vector for HIV transmission (Hartzell et al,2008)
 Decrease quality of life
 Affect (Antelman et al,2007) and could be
markers (Hutchinson et al,2005) of HIV disease
progression
 Adherence to drugs ( Gordillo et al,1999)
 Ability to cope with standard procedures of HIV
care (Holzemer et al,1999)
 However, most go unnoticed & untreated
Background
Prevalence estimates have varied,
generally ranging from 2 – 48%.
 Some studies have had higher estimates82.6% (Ovuga et al, 2005)
 Many have used screening instruments
which may overestimate actual prevalence

Background
Predictors of psychiatric disorders have
varied
 Clinical stage (Adewuya et al 2007) and
lower economic status/income
 No association with clinical stage, but
unemployment, living alone & work
related disabilities
 Young age(Myer L et al,2008)

Background
The burden of HIV in Zambia is high
 At the end of 2009, prevalence of HIV in
Zambia estimated to be 14.3% ranking it
seventh among countries most affected
(Zambia UNGASS, 2010)
 Results from a Zambian study suggested
that HIV infection has a substantial
influence on mental distress (Chipimo et
al, 2009)

Study Justification
The prevalence of HIV in Zambia is high
 Prevalence of psychiatric disorders in HIV
population in Zambia is not known
 Knowledge of the local burden will help
in policy and planning purposes
 Knowledge of the local correlates will
alert physicians to identify susceptible
individuals who may require further
evaluation

Objectives
Main Objective
 To determine the prevalence and corelates of psychiatric disorders in HIV
positive patients attending an HIV clinic at
Chilenje Health centre in Lusaka, Zambia.
Specific Objectives
To determine the prevalence of
psychiatric disorders in HIV positive
patients
 To examine demographic, psychosocial
and clinical correlates in HIV patients
who present with psychiatric disorders
 To describe implications of psychiatric
disorders in HIV

Methodology
Study Design
 Cross sectional study
Site
 Chilenje Health centre- a primary health
facility, located south east of the city
centre
Methodology
Sample size
 Based on expected 48% prevalence of
psychiatric disorders in HIV patients, I will
need 370 patients at precision of +/-5%
and 95% confidence interval
Sampling
 Systematic sampling
Methodology
Study Procedure and Tools
The following tools will be used:
 The Mini International Neuropsychiatric
Interview for psychiatric diagnosis.
 A standardized demographic
questionnaire,
 Multi dimensional social support scale
 The HIV treatment adherence self efficacy
scale
Methodology
Study Procedure and Tools
 General physical examination
 Blood sample collection on the spot
 Brain Imaging
Methodology
Dependant Variables
 Psychiatric diagnoses
Independent Variables
Demographic
Age
 Gender
 Marital status
 Education level
 Occupation
 Income status
Psycho-social
 Social support
 Number of sexual partners
 Adherence to ART

Clinical







Median time since HIV
diagnosis
CD4 count
Viral load
Duration of ART use
Opportunistic infections
WHO clinical stage
CRP
Methodology
Methodology
Data Collection and Analysis
 By Epi info software package
 Logistic regression models will be used to
evaluate demographic, psychosocial and
clinical factors that will correlate with
psychiatric diagnoses.
Ethical considerations
Approval by the University of Zambia
Research and Ethics Committee will be
sought.
 Informed consent will be sought from
the participants
 Numbers will be assigned for the
purpose of confidentiality.
 Patients diagnosed with psychiatric
disorders will be referred appropriately

Study Limitations
Cross sectional study
 Causal relationships difficult to establish


Generalization of findings to other ART
programs
Future Prospects
Case control study
 Prevalence in different stages of HIV
disease

Acknowledgements
Dr Gil Blackwood, Honorary Lecture
Department of Psychiatry, University of
Zambia
 Dr Ravi Paul, Consultant/Lecturer,
University of Zambia

References
Glenn Treisman ,‘ The infectious disease specialist and the Psychiatrist:
Understanding the psychiatric issues in the treatment of HIV infected
patients’ Advanced studies in medicine, May 2002 vol.2 No 6
 Chandra P ‘HIV and psychiatric disorders,’ Indian J Med Res 121 April
2005,ppv451-467
 Hartzel J. ‘ Impact of depression on HIV outcomes in the HAART era,’ Journal
of Anti-microbial Chemotherapy (2008) 62;256-255
 Antelman G. ‘ Depressive symptoms increase risk of HIV disease progression
and mortality among women in Tanzania,’ J Acqui Immune Defic Syndr (2007)
44; 470-472
 Hutchinson G ‘Hiv mania as a marker for clinical deterioration in AIDS,’ West
Indian Med J 2005; 54(2) 149
 Holzemer W. ‘Predictors of self reported adherence in persons living with HIV
disease,’ AIDS Patient Care and STDs vol 13 Num 3, 1999
 Ovuga E. ‘Psychiatric disorders in HIV positive individuals in urban Uganda,’
The Psychiatrist (2005)29; 455-458
 UNGASS Zambia UNGASS country progress report on HIV and AIDS, March
2010
 Chipimo P. ‘Mental distress in the general population in Zambia: Impact of
HIV and social factors,’ BMC public health (2009) 9: 298
