Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa

  • Jennifer M. Belus
  • Rushina CholeraEmail author
  • William C. Miller
  • Jean Bassett
  • Bradley N. Gaynes
Original Paper


Psychiatric comorbidity, the presence of two or more psychiatric disorders, leads to worse HIV outcomes in the United States; this relationship has not been studied in sub-Saharan Africa. We conducted a preliminary study to describe the prevalence of psychiatric comorbidity (unipolar mood, anxiety, and trauma disorders) among 363 adults prior to HIV testing at Witkoppen Health and Welfare Centre, a primary care clinic in Johannesburg, South Africa. We also examined whether psychiatric comorbidity predicted subsequent linkage to HIV care 3 months later. Prevalence of psychiatric comorbidity prior to HIV testing was approximately 5.5%. In the final HIV-positive subsample (n = 76), psychiatric comorbidity of unipolar mood, anxiety, and trauma disorders did not predict linkage to care [adjusted relative risk = 1.01 (0.59, 1.71)] or number of follow-up appointments (adjusted relative risk = 0.86 (0.40, 1.82)]. A similar psychiatric profile emerged for HIV-positive and HIV-negative individuals before becoming aware of their HIV status. The psychiatric burden typically seen in HIV-positive individuals may manifest over time.


Psychiatric comorbidity Psychiatric disorders HIV Linkage to care South Africa 



This work was supported by the National Institute of Mental Health Grant 5F30MH096664, and National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium comprised of the University of North Carolina, John Hopkins, Morehouse and Tulane (1R25TW009340-01) and the American Recovery and Reinvestment Act. Financial support for REDCAP was provided by Grant UL1RR025747 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Research Involving in Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of MarylandCollege ParkUSA
  2. 2.Department of Pediatrics, UNC School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusUSA
  4. 4.Witkoppen Health and Welfare CentreJohannesburgSouth Africa
  5. 5.Department of Psychiatry, UNC School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA

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