Prevalence and factors associated with anxiety among people living with HIV/Aids in Moshi municipality, Kilimanjaro region, Tanzania

Abstract

ABSTRACT Human immunodeficiency virus (HIV) is a retroviral infection that weakens the immune system. If left untreated, HIV progresses to the acquired immunodeficiency syndrome (AIDS). In Tanzania, 1.6 million of about 70 million people live with HIV (PLWHA) and are more prone to mental health illnesses such as generalized anxiety disorder that may affect clinical outcomes. While several generalized anxiety risk factors in PLWHA have been identified elsewhere, there is a limited understanding of the prevalence of significant anxiety symptoms and its associated risk factors among adult PLWHA in the Tanzanian context. Objective: To determine the prevalence of significant anxiety symptoms and associated risk factors among adult PLWHA attending selected HIV clinics (CTC centers) in Moshi Municipality, Kilimanjaro Region Materials and methods: The study used a hospital-based cross-sectional quantitative analytical design at CTCs in Moshi Municipality, in the Kilimanjaro region. Four out of 19 CTCs were randomly selected using multistage cluster sampling. A systematic random sampling approach enrolled adult PLWHA (18 years and older) participants in the study from September to October 2023. Data was collected using face-to-face interviews by Redcap software version 5.27.2. Significant anxiety symptoms were assessed using a validated Swahili version of a 7-item Generalized Anxiety Disorder Screener. A semi structured questionnaire captured the social demographic and clinical information characteristics of participants. STATA version 15 was used to enter and analyze data, respectively. The sample’s description was summarized using frequency distributions for categorical measures, mean with standard deviations (SD), and medians with interquartile ranges for continuous variables. Bivariate analyses identified risk factors associated with significant anxiety symptoms at p-values ≤0.20 for inclusion in logistic regression models to determine independent risk factors at p-values <0.05. The MUHAS Senate Research and Publications Committee provided ethical clearance and permission sought from the respective research CTCs. Results: A total of 593 PLWHA participated in the study, 429 of whom were female (72.3%). The mean age of participants was 47.5 years (SD=13.2), and 12.5% screened positive for significant anxiety symptoms. Participants treated at the tertiary health facility level compared to the primary showed a seven times higher likelihood of significant anxiety symptoms (AOR=7.4, 95% CI: 6.14-9.04, P-value=0.00). Significant anxiety symptoms were associated with reported substance use compared to none, increasing the likelihood nearly five-fold (AOR= 4.69, 95% CI: 1.12-19.53, P-value = 0.03). Screening positive for probable depression versus not increased by five times the likelihood of significant anxiety symptoms (AOR= 5.02, 95% CI: 2.34-11.06, P-value = 0.00). Similarly, participants with high compared to those with low anxiety sensitivity were 15 times more likely to have significant anxiety symptoms (AOR= 15.39, 95% CI: 3.88-61.14, P-value = 0.00). PLWHA reporting low, compared to those reporting higher adaptive coping mechanisms, were three times more likely to have significant anxiety symptoms (AOR= 3.48, 95% CI: 1.43-8.46, P-value = 0.01). Reporting higher compared to low levels of perceived social support increased three times the likelihood of developing significant anxiety symptoms (AOR=3.35; 95% CI: 1.61-6.96, P-value = 0.00). Conclusions: Significant anxiety symptoms were common, affecting one in eight adult PLWHA in this study. Receiving care at CTCs located in higher health facility levels, using substances of abuse, screening positive for probable depression, high anxiety sensitivity, higher social support, or low use of adaptive coping mechanisms were associated with significant anxiety symptoms. Recommendation: Integrating routine anxiety screening in PLWHA and raising awareness among patients and their primary caregivers is recommended