HIV care interruptions, mental health, and the potential for mHealth interventions among adolescents and young adults with HIV in Uganda

Abstract

Objective: HIV care interruptions contribute to adverse outcomes among adolescents and young adults with HIV (AYWH) and may occur due to structural barriers as well as comorbidities (e.g., mental health issues). This study characterizes a cohort of AYWH, examines the frequency of care interruptions, and assesses mental health issues during and after the COVID-19 pandemic while exploring mobile health (mHealth) potential. Methods: Using a retrospective and prospective cohort study design, we enrolled AYWH at Mbarara Regional Referral Hospital and assessed missed visits using the timeline follow-back method (24 months). Mental health was evaluated using the Centers for Epidemiological Disease Scale-Depression (CES-D; >15 considered significant) and a locally validated anxiety/psychosocial distress scale (score 0–100) at enrolment, three and six months. Access to mobile phones, smartphones and internet was also assessed. Results: Of 86 participants (mean age 18.6 years, 51.2% male), 89.5% had a viral load of< 400 copies/ml. At enrolment, 53% had depression, with mean anxiety/psychosocial distress of 36.7. AYWH missed 19.0% of clinic visits, 3.2% of ART pickup visits, and 5.1% of laboratory visits, with no clear variation by pandemic phase. Depression and anxiety decreased significantly over 6-months (β=– 0.46; 95% CI – 0.73, – 0.19; p< 0.001) and (β=– 1.25; 95% CI – 1.65, – 0.86; p=0.001) respectively. Most AYWH (59%) had mobile phone access, with 67% of those owning a smartphone and 71% having daily internet access. Discussion/conclusion: AYWH frequently missed clinic appointments, regardless of pandemic phase. Mental health symptoms were initially high, but decreased over time. Most AYWH had access to phones and the internet. Conclusion: To ensure continuity of HIV care and mental health support even during such disruptions, mHealth interventions may offer a viable solution and warrant further research.