UMEED

Objective
The aim of this project is to investigate the impact of psychosocial health concerns on help-seeking behaviours in people coming to be tested for HIV/AIDS. We will investigate this by recruiting and interviewing 2140 attendees of pre-test counseling at the Goa Medical College Integrated Counselling and Testing Centre (ICTC).

Our earlier work in the area of mental health problems among People Living with HIV (PLHIV) revealed that many people with HIV / AIDS tend to get depressed, which in turn may impact on their treatment seeking behaviour and overall health.

Records show that many who attend pre-test counselling at the Integrated and Counselling Centre (ICTC) at the Goa Medical College do not return to collect their test results. There are also people who collect test results, but do not attend appointments at the Anti-Retroviral Therapy (ART) Centre.

For better health outcomes in PLHIV, it is important that people tested at the ICTC attend follow-up appointments made with counsellors and doctors at the Goa Medical College (GMC). They can be provided advice and have access to the free care and treatment available in Goa. It is possible that mental health problems may affect access and utilization of care by PLHIV.

Background
The Umeed research study attempted to systematically measure the presence of mental health problems, like depression and alcohol abuse, in people attending ICTC and its impact on their attendance of follow-up appointments with doctors at the ART Centre.

Umeed started recruitment and data collection from November 2008 at the ICTC in GMC. We completed fifteen months of baseline data collection and the study was well-integrated within the day-to-day running of the centre.

Trained researchers based at the GMC Integrated Counselling and Testing Centre (ICTC) recruited people attending pre-test counselling for HIV/AIDS.The baseline interviews included measures of mental disorder and cognitive functioning, as well as questions on other psychosocial factors, such as experiencing or perpetrating violence in intimate partnerships, and on pathways of testing.

Follow-up data was collected from the routine records of counsellors at the ICTC on the HIV status of the participants and the participant’s attendance at post-test counselling sessions.For HIV positive participants, data were collected from the counsellor and the doctor at the ART Centre at Goa Medical College. This included the participants’ attendance at the ART centre for initial assessment, appointments kept, their CD4 count, whether they began anti-retroviral therapy and other clinical outcomes. The data collection phase has been completed and analysis is in progress.

Impact
If the study shows evidence of mental health problems being a barrier to accessing HIV-related services and adherence with care, this would provide evidence to support the integration of mental health care within HIV detection and treatment services.

Screening for mental disorder and provision of appropriate support and treatment for mental disorders could help improve uptake of HIV services and adherence to ART regimens, ultimately improving overall outcomes in PLHIV.