02668nas a2200313   4500000000100000008004100001653001100042653001700053653000800070653001600078653002400094653001200118653001500130653001800145653001200163100001900175700002200194700001200216700001500228700001100243700001800254700001500272245013200287856003200419300001000451490000700461520187200468022001402340       2017                            d10aStigma10aTuberculosis10aHIV10aAlcohol use10aTB-HIV co-infection10aalcohol10aDepression10aMental Health10aLesotho1 aHayes-Larson E1 aHirsch-Moverman Y1 aSaito S1 aFrederix K1 aPitt B1 aMaama-Maime L1 aHoward A A00aDepressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho.  uhttp://tinyurl.com/yd5nl2fw  a34-410 v213 a<p><strong>SETTING: </strong>Limited data exist on the prevalence and correlates, including stigma, of mental health conditions, including depressive symptoms and alcohol use, among patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) in sub-Saharan Africa, despite their negative impact on health outcomes.</p>

<p><strong>OBJECTIVE: </strong>To assess the prevalence and correlates of depressive symptoms and hazardous/harmful alcohol use among TB-HIV patients in the Start TB patients on ART and Retain on Treatment (START) study.</p>

<p><strong>DESIGN: </strong>START, a mixed-methods cluster-randomized trial, evaluated a combination intervention package vs. standard of care (SOC) to improve treatment outcomes in TB-HIV co-infected patients in Lesotho. Moderate/severe depressive symptoms and hazardous/harmful alcohol use were measured using baseline questionnaire data collected from April 2013 to March 2015. Demographic, psychosocial, and TB- and HIV-related knowledge and attitudes, including stigma, were assessed for association with both conditions using generalized linear mixed models.</p>

<p><strong>RESULTS: </strong>Among 371 participants, 29.8% reported moderate/severe depressive symptoms, and 24.7% reported hazardous/harmful alcohol use; 7% reported both. Depressive symptoms were significantly associated with less education, more difficulty understanding written medical information, non-disclosure of TB, greater TB stigma, and the SOC study arm. Hazardous/harmful alcohol use was significantly associated with male sex, as well as greater TB and external HIV stigma.</p>

<p><strong>CONCLUSION: </strong>Prevalence of depressive symptoms and hazardous/harmful alcohol use were high, suggesting a need for routine screening for, and treatment of, mental health disorders in TB-HIV patients.</p>
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