Abstract / Summary
Mental health disorders (MHDs) are prevalent among adolescents and young people living with HIV (AYPLHIV) and can adversely affect wellbeing, antiretroviral therapy adherence and engagement in care. We aimed to determine the prevalence of common MHDs and associated factors among AYPLHIV receiving routine HIV care in Lusaka, Zambia. We conducted a cross-sectional survey embedded within the AdoMinds mixed-methods implementation study. The study was conducted from September 2023 to May 2024 at Chipata Level 1 Hospital, Lusaka. All AYP aged 15-24 years enrolled in ART care during the study period were invited to participate. A trained research assistant administered a tablet-based questionnaire including validated screening tools for depression, anxiety, post-traumatic stress disorder and substance use. Logistic regression was used to determine factors associated with MHDs. We enrolled 416 AYPLHIV (71.4% of 583 registered in care); 268 (64.4%) were female and the median age was 20 years (IQR: 18, 23). Overall 71.4% (297/416) screened positive for at least one MHD. Depression was most prevalent at 67.1% (279/416), followed by anxiety at 35.3% (147/416). Having at least one MHD was associated with feeling stigmatised because of HIV (AOR = 1.99, 95% CI: 1.10-3.63, p = 0.024). There was borderline evidence that a history of smoking was associated with higher odds of having at least one MHD (AOR = 4.24, 95% CI: 0.98-18.30, p = 0.053). Compared with participants with both parents alive, having lost one parent (AOR = 0.46, 95% CI: 0.21-0.97, p = 0.042) or both parents (AOR = 0.38, 95% CI: 0.18-0.80, p = 0.010) was associated with lower odds of having an MHD. Common MHDs were highly prevalent among AYPLHIV receiving routine HIV care, with HIV-related stigma associated with higher odds of MHDs. Integrating mental health screening and referral pathways into adolescent HIV services may support earlier identification and care.