Clinician's knowledge, attitude and self efficacy in managing depression among people leaving with HIV-AIDS in Dar es salaam Tanzania

Abstract

Background: People living with HIV/AIDS (PLHA) are significantly more distressed than the normal population, yet psychiatric disorders are commonly under-detected in HIV care settings. Some evidence shows that a high prevalence of mental health co-morbidities, particularly major depressive disorder, occurs in PLHA accessing care at primary health care levels. Depression is a prevalent and disabling, yet potentially treatable illness. Challenges posed by mental health eo morbidities to many clinicians include their recognition and diagnosis. Indeed studies show that knowledge, attitudes towards addressing psychological health concerns and ineffective training are important barriers in managing depression among PLHA. Studies also show that simple screening tools, some that have been validated in the proposed study area, have the utility in assisting non-specialized health care providers in assessing for depression in the primary health care context. Identifying issues affecting Health care provider s abilities to diagnose and treat depression in persons living with HIV AIDS is crucial to informing current HIV and AIDS management paradigms.

Objective: To ascertain clinicians knowledge, attitudes, perceived self efficacy and associated determinants in recognition and treatment of depression in PLHA attending HIV/AIDS care and treatment clinics (CTCs) in Dar es Salaam

Study site and design: A descriptive cross-sectional study was conducted between November 2009 and April 2010 in Dar es Salaam. It involved 50 private and public CTCs supported by Muhimbili University, Dar es salaam City health department and Harvard School of Public Health collaboration program (MDH). Method: A self administered previously used researcher modified questionnaire was distributed to 109 eligible clinicians who work with MDH supported CTCs in Dar es Salaam. Clinicians knowledge in diagnosis and treatment of depression, attitudes attributed to patients as well as perceived barriers and self efficacy in the recognition and treatment of depression were assessed. Data analysis was done using univariate and multivariate statistical analysis

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with significant level set at when p<0.005. Results: Of the 109 clinicians with known eligibility, 84 (78%) returned the questionnaire. Of those who returned the forms, 38 (55.8%) were males, 50 (59.5%) were based in public health facilities and most were non physician clinicians 52 (62.7%). Among them 95%, 91.7%, 72.6% and 42% reported exposure to training on ART, adherence counseling, management of mental disorders and psychosocial issues related to HIV respectively. Majority reported correct knowledge oh recognition 84 (63.7%) while a third reported correct knowledge in treatment of depression 84 (32.32%). Female clinicians reported higher knowledge on core symptoms for diagnosis of depression 36 (66.96%) than male clinicians 46 (61.56%) p<0.003 and physician clinicians were observed to have higher knowledge on treatment of depression 31 (41 %) than non physician clinicians 52 (27%) p<0.005. Clinicians own attitudes to manage depression was more negative (mean score 1.96, SD 0.90) than those they attributed to patient (mean score 2.14, SD 0.78). Generally clinicians perceived many barriers to recognition and treatment of depression scoring a mean (SD) in policy and guideline 1.89 (1.15) and clinical setting 1.34 (1.1). While clinicians reported perceived self efficacy to be high (mean score 2.87, SD 0.07) it did not vary significantly with attitudes, knowledge or site and individual factors. However self motivation to treat depression was significantly associated with higher perceived self efficacy (p<0.00 1).

Conclusion and recommendations: The recognition and treatment of depression in PLHA remains a challenge for clinicians in CTCs settings. Clinicians negative attitudes, perceived barriers and lack of adequate knowledge in recognition and treatment of depression impede the efforts to address depression in PLHA attending CTCs. Interventions to increase recognition and treatment of depression will need to focus on strategies that enhance clinicians motivation to do so, in-service trainings and use of users friendly tools. These findings are crucial to informing the current gap in addressing common mental problems faced by PLHA attending CTCs.