Psychological problems of HIV-infected patients in preparing to the start of antiretroviral therapy

Objectives: to find out and. analyze the problems of HIV-infected. patients which require additional attention of specialists during counseling before the start of antiretroviral therapy as well as to assess patients' needs in psychological help.

Materials and methods: the data are collected, by the questionnaire and. psychometrical screening using The Somatic Symptom. Disorder — B Criteria Scale from 365 HIV-infected. patients, including 155 (42,5%) females who took part in the group psychological counseling for preparing to the start of antiretroviral therapy from July 2017 to July 2018. The average age was 37.2 years old.

Results: the difficulties due to HIV-infection, which, are mentioned, by patients before the therapy start, are ranged, by the frequency of their answers as follows: 1) ««need, to conceal HIV diagnosis» — 27,1% answers, 2) ««lack of time for visiting the doctor» — 26,6%; 3) ««depression and/or anxiety» — 26,0%; 4) ««need, to use condom» — 19,5%; 5) ««restrictions in employment» — 10,1%; 6) ««disclosure of HIV diagnosis to the partner» — 8,5%. Less common are ««difficulties to interact with the doctor» (4,4%), ««impossibility to work in the specialty» (4,4%) and. ««the rejection from significant others» (4,1%). The monitoring of HIV treatment adherence showed, that 31,8% of patients were not ready to start taking medications right after the doctor's recommendations, and. 13,4% postpone the start of treatment for more than half a year.

Conclusion: in preparation for the start of antiretroviral therapy a patient needs the assistance in time scheduling required. for treatment. The discussion, with patients about their attitudes towards condom use and their self-efficacy to use condom, helps patients to overcome their fear of HIV diagnosis disclosure and. therefore reduces their risky sexual behavior. Psychological screening helps revealing psychological tension and allows offering the consultation of psychiatrist or psychologist with the purpose to correct mental state as well as to facilitate patient's efforts to develop adherence to continual treatment.

1. Koltsova O.V. «Shkola pazienta» — prostranstvo dlya sozdaniya u VICh-infizirovannykh pazientov soznatelnoy ustanovki na otvetstvennoe povedenie / O.V. Koltsova, L.A. Senkovski, P.V. Safonova, A.V. Gaysina, A.G.Khanevskaya // Almanakh «Infeczionnye bolezni — 2015» / pod redacziey A.G. Rakhmanovoy, A.A. Yakovleva. — SPb: Izd. VVM, 2015. — S. 141-147. [In Russian].

2. Koltsova O.V. Skriningovaya otsenka urovnya distressa i vyrazhennosti psichopatologicheskikh simptomov u VICh-infizirovannykh pazientov / O.V. Koltsova, A.V. Gaysina, V.Yu. Rybnikov, V.V. Rassokhin // VIHc-infecziya i immunosupres-sii, 2013. - Т.5, № 2. S. 35-41. [In Russian].

3. Koltsova O.V. Lichnostnye osobennosti i podderzhanie nepreryvnosti lecheniya u VICh-infizirovannykh pazientov / O.V. Koltsova, P.V. Safonova, V.Yu. Rybnikov, M.A. Shtern // Vestnik Sankt-Peterburgskogo Universiteta. Seriya 16: psi-chologiya, pedagogika. — 2013. — Vypusk 4. — S.49 — 59. [In Russian].

4. Toussaint A, Murray AM, Voigt K, Herzog A, Gierk B, Kroenke K, Rief W, Henningsen P, Lowe B. Development and Validation of the Somatic Symptom Disorder—B Criteria Scale (SSD-12). Psychosomatic Medicine. 2016. Vol. 78 (1): 5-12.

5. Pokrovskiy V.V. Protokoly dispansernogo nablyudeniya i lecheniya bolnykh VIHc-infecziey / V.V. Pokrovskiy, [i dr.]. // Epidemiologiya i infeczionnye bolezni. Aktualnye voprosy. — 2014. — № 6. [In Russian].

6. Agaba PA, Meloni ST, Sule HM, et al. Patients who present late to HIV care and associated risk factors in Nigeria. HIV Med. 2014 Aug;15(7):396-405.

7. Parcesepe AM, Tymejczyk O, Remien R, et al. Psychological distress, health and treatment-related factors among individuals initiating ART in Oromia, Ethiopia. AIDS Care. 2018 Mar;30(3):338-342.

8. Klinicheskie rekomendazii. VICh-infecziya u vzroslykh. Ministerstvo zdravookhraneniya RF, 2017. (Elektronnyi resurs: https://arvt.ru/sites/default/files/rf-2017-protokol-vich-vz-roslie.pdf Data obraszheniya: 13.02.2019). [In Russian].

9. Doherty M. New directions in the 2015 WHO Consolidated ARV Guidelines. 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015), Vancouver, Canada. SUSA0608, 2015.

10. Federalnyi zakon ot 30 marta 1995 g. N 38-FZ "O predu-prezhdenii rasprostraneniya v Rossiyskoy Federazii zabolevani-ya, vyzyvaemogo virusom immunodefizita cheloveka (VICh-infeczii)". [In Russian].

11. Federalnyi zakon ot 21.11.2011 N 323-FZ «Ob osnovakh ohrany zdoroviya grazhdan v Rossiyskoy Federazii». [In Russian].

12. Nachega JB, Morroni C, Zuniga JM, et al. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Physicians AIDS Care (Chic). 2012 May-Jun;11(3):172-8.

13. Lifson AR, Grund B, Gardner EM, et al. Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS. 2017 Apr 24;31(7):953-963.

14. Krasnoselskikh T.V. Ustanovki v otnoshenii zaschisch-ennogo seksa u posetiteley uchrezhdeniy venerologicheskogo profilya / T.V. Krasnoselskikh, A.V. Shaboltas, R.V. Skochilov, N.V. Nold, N. Abdala, A.P. Kozlov // Sovremennye problemy dermatovenerologii, immunologii I vrachebnoy kosmetologii. — 2010. — Т. 2, № 2. — S. 45-52. [In Russian].

15. Langen TT. Gender power imbalance on women's capacity to negotiate self-protection against HIV/AIDS in Botswana and South Africa. Afr Health Sci. 2005;5(3):188—197.

16. Anderson ES, Wagstaff DA, Heckman TG, et al. Information-Motivation-Behavioral Skills (IMB) Model: testing direct and mediated treatment effects on condom use among women in low-income housing. Ann Behav Med. 2006; 31 (1): 70-79.

17. Polacsek, M. Correlates of condom use stage of change: implications for intervention / M. Polacsek, D. D. Celentano, P. O'Campo, J. Santelli // AIDS Educ Prev.1999; 11 (1): 38-52.