Comparison of routine versus selective screening strategies for depression among PLHIV attending Princess Diana Memorial Health Centre iv Soroti.

Abstract

Abstract Introduction: Depression is not usually screened for among PLHIV in Uganda in spite of the fact that depression is more common among PLHIV than in the general population. The study’s aim was to determine whether selective and routine screening strategies for depression differed in case detection, and performance (sensitivity and specificity); and to describe the perceptions of stake holders on the screening strategies. Methods: The study employed a mixed methods study design with quantitative (a randomized control trial) and qualitative data collection methods. It was conducted in Princess Diana Memorial Health Centre IV HIV clinic. Ethical approval was sought from School of Medicine Research Ethics Committee (REC 2018-041) while registration was done with the Pan African Clinical Trial Registry (PACTR201802003141213). 291 PLHIV and 6 stake holders participated in the study. Participants allocated to selective screening were screened for depression if they had or were at “crisis points” while those allocated to routine screening were screened regardless of whether they had or were at “crisis points” or not. The screening was done at every clinic visit. The PHQ-2 and PHQ-9 were used in sequence for screening while the MINI was used as the reference tool. Audio recorded Key informant interviews were carried out to identify the perceptions of the stake holders. Results: Routine screening detected 8.4% more cases P-value =0.073, 95% confidence interval (-0.8%, 17.6%) (two sided). Sensitivity was significantly higher for routine screening as compared to selective screening strategy (difference =23.7%) P -value = 0.034, 95% confidence interval (2.6%, 44.9%). The stake holders thought it was important to screen for depression among PLHIV with preference to routine screening strategy. Conclusion: The findings indicated that PLHIV should be screened for depression regardless of whether they present with risk factors (“crisis points”) or not given the difference in sensitivity of the strategies, and the stake holders’ concerns. This should be supported with trainings, public sensitization on depression and improvement of the Health information Management System to capture data on depression among PLHIV