Abstract
Background: Advances in HIV therapeutics for women living with HIV (WLWH) in sub-Saharan Africa have shifted focus from deadly AIDS to chronic disease management. This shift underscores the need for integrated mental health and HIV care in low-resource settings, particularly addressing medical comorbidities and antiretroviral (ARV) side effects that exacerbate anxiety and depression. Conditions such as anemia, diabetes, hypertension, and malaria, alongside ARV-related side effects like chronic pain, fatigue, and neuropathy, contribute to overlapping physical and mental health symptoms and challenges. Integrating mental health screening into primary care facilitates identifying primary and secondary symptom etiologies, optimizing outcomes. Urban and rural WLWH face distinct barriers, stressors, and resources, necessitating context-specific approaches. Expanding nursing education and roles may address critical healthcare access constraints.
Objectives: This study aims to: (1) compare the prevalence and severity of anxiety (GAD-7) and depression (PHQ-9) in rural and urban Kenyan WLWH living in poverty; (2) identify medical comorbidities and physical symptoms associated with these mental health conditions and +HIV status; (3) explore context-specific factors influencing mental health outcomes in urban versus rural cohorts; (4) demonstrate enhanced health screening access with expanded nursing role on multidisciplinary teams.
Methods: A cross-sectional, comparative observational study will recruit widowed WLWH enrolled in a Women’s Employment and Empowerment Program (WEEP) run by a Kenyan non-governmental organization (NGO) in rural and urban areas. Participants receive equal financial support, skills training, and healthcare oversight. A mobile multidisciplinary medical team, led by the NGO physician and including Kenyan and U.S. nursing faculty, advanced practice nurses and registered dietician, will conduct comprehensive health assessments. Data to include mental health metrics (GAD-7, PHQ-9), medical comorbidities (hypertension, diabetes, anemia, chronic pain, secondary cancer), and contextual factors.
Data Analysis: Rural-urban differences in mental health and medical conditions will be analyzed using t-tests or Mann-Whitney U-tests. Multivariable regression will assess associations between GAD-7/PHQ-9 scores and medical comorbidities, controlling for demographic and contextual variables.
Implications: Tailor interventions to unique rural and urban contexts
Notes
References: 1. Ciancio, A., Kämpfen, F., Kohler, H. P., & Kohler, I. V. (2021). Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa. Journal of Health Economics, 75, 102388. https://doi.org/10.1016/j.jhealeco.2020.102388
2. Christmals, C. D., & Armstrong, S. J. (2020). Curriculum framework for advanced practice nursing in sub-Saharan Africa: A multimethod study. BMJ Open, 10(6), e035580. https://doi.org/10.1136/bmjopen-2019-035580
3. Eshun-Wilson, I., Siegfried, N., Akena, D. H., Stein, D. J., Obuku, E. A., & Joska, J. A. (2018). Antidepressants for depression in adults with HIV infection. The Cochrane Database of Systematic Reviews, 1(1), CD008525. https://doi.org/10.1002/14651858.CD008525.pub3
4. Gbaba, S., & Itambo, J. (2023). Advanced practice registered nurses: A solution for primary care shortages in sub-Saharan Africa. Nursing Open, 10(9), 5787–5789. https://doi.org/10.1002/nop2.1909
5. Mwangi, P., Nyongesa, M. K., Koot, H. M., Cuijpers, P., Newton, C. R. J. C., & Abubakar, A. (2020). Validation of a Swahili version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to a community sample from Kilifi, Kenya. Journal of Affective Disorders Reports, 1, 100013. https://doi.org/10.1016/j.jadr.2020.100013
6. Nyongesa, M. K., Mwangi, P., Koot, H. M., Cuijpers, P., Newton, C. R. J. C., & Abubakar, A. (2020). The reliability, validity and factorial structure of the Swahili version of the 7-item generalized anxiety disorder scale (GAD-7) among adults living with HIV from Kilifi, Kenya. Annals of General Psychiatry, 19, 62. https://doi.org/10.1186/s12991-020-00312-4
Sigma Membership
Zeta Eta at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Quantitative Research
Keywords:
Academic-clinical Partnership, Global Leadership, Primary Care, Clinical Practice, Health Promotion, Disease Prevention, HIV Management, Anxiety, Depression, Kenya
Recommended Citation
Van Auker, Laura L.; Wagoro, Miriam; Meda, Janet; and Omenda, Mariana Javeza, "Anxiety, Depression and Associated Medical Symptoms in Kenyan HIV+ Women: Rural vs. Urban Context" (2025). Biennial Convention (CONV). 141.
https://www.sigmarepository.org/convention/2025/presentations_2025/141
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-01
Anxiety, Depression and Associated Medical Symptoms in Kenyan HIV+ Women: Rural vs. Urban Context
Indianapolis, Indiana, USA
Background: Advances in HIV therapeutics for women living with HIV (WLWH) in sub-Saharan Africa have shifted focus from deadly AIDS to chronic disease management. This shift underscores the need for integrated mental health and HIV care in low-resource settings, particularly addressing medical comorbidities and antiretroviral (ARV) side effects that exacerbate anxiety and depression. Conditions such as anemia, diabetes, hypertension, and malaria, alongside ARV-related side effects like chronic pain, fatigue, and neuropathy, contribute to overlapping physical and mental health symptoms and challenges. Integrating mental health screening into primary care facilitates identifying primary and secondary symptom etiologies, optimizing outcomes. Urban and rural WLWH face distinct barriers, stressors, and resources, necessitating context-specific approaches. Expanding nursing education and roles may address critical healthcare access constraints.
Objectives: This study aims to: (1) compare the prevalence and severity of anxiety (GAD-7) and depression (PHQ-9) in rural and urban Kenyan WLWH living in poverty; (2) identify medical comorbidities and physical symptoms associated with these mental health conditions and +HIV status; (3) explore context-specific factors influencing mental health outcomes in urban versus rural cohorts; (4) demonstrate enhanced health screening access with expanded nursing role on multidisciplinary teams.
Methods: A cross-sectional, comparative observational study will recruit widowed WLWH enrolled in a Women’s Employment and Empowerment Program (WEEP) run by a Kenyan non-governmental organization (NGO) in rural and urban areas. Participants receive equal financial support, skills training, and healthcare oversight. A mobile multidisciplinary medical team, led by the NGO physician and including Kenyan and U.S. nursing faculty, advanced practice nurses and registered dietician, will conduct comprehensive health assessments. Data to include mental health metrics (GAD-7, PHQ-9), medical comorbidities (hypertension, diabetes, anemia, chronic pain, secondary cancer), and contextual factors.
Data Analysis: Rural-urban differences in mental health and medical conditions will be analyzed using t-tests or Mann-Whitney U-tests. Multivariable regression will assess associations between GAD-7/PHQ-9 scores and medical comorbidities, controlling for demographic and contextual variables.
Implications: Tailor interventions to unique rural and urban contexts
Description
This study will provide critical insight into mental health disparities and comorbidities among rural and urban Kenyan women living with HIV, informing tailored, integrated care strategies for this at-risk population. Demonstration of interprofessional teams using nurses with advanced practice training enhances screening capacity, modeling an integrated approach to improved management of comorbidities related to anxiety and depression, chronic disease, HIV and antiretroviral side effects.