HIV prevalence and access to HIV testing and care in patients with psychosis in South Africa

Abstract

Background: Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental illness often have limited or reduced access to HIV testing and care.

Aim: This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa.

Setting: A psychiatric hospital in Pietermaritzburg, KZN province, South Africa.

Method: A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020.

Results: A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients; HIV seropositivity was associated with the 25–49 age category (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] 1.27–7.50), female gender (aOR = 9.55, 95% CI 4.40–20.74), current alcohol and cannabis use (aOR = 3.43, 95% CI 1.01–11.62), family history of psychosis (aOR = 3.22, 95% CI 1.03–10.02) and no tertiary education (aOR = 3.7, 95% CI 0.14–0.99). All those living with HIV were on antiretroviral treatment.

Conclusion: This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high.

Contribution: The study findings suggest the importance of integrating mental health and HIV management.