People living with HIV are experiencing higher rates of anxiety, depression and sleep issues

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Nicola Galbraith, senior manager, Gilead HIV Standards Support Team

This article and the ‘Psychological Wellbeing and sleep’ education modules have been organised, developed and funded by Gilead Sciences, with input from experts in HIV, Psychological Wellbeing and Sleep.

During my time as a HIV clinical nurse specialist within the NHS, I was witness to the evolution of HIV care from acute in nature to one of an often manageable, long-term condition. This is testament to the great progress that has been made in HIV and a welcome shift, however, one which comes with a number of new and evolving challenges.

Now, working alongside fellow HIV nurses as part of the Gilead HIV Standards Support Team, we are able to utilise our own experiences and insights to help shape how industry can provide valuable, additional support to HIV services.

Recently, this has seen us, in collaboration with clinical and community experts, develop a series of educational training resources to support healthcare professionals in having conversations about sleep and psychological wellbeing among people living with HIV.

People living with HIV are disproportionately affected by psychological wellbeing and sleep issues (Chaponda et al, 2017)

The relationship between HIV, mental health, and sleep is deeply intertwined (Croston and Rutter, 2020; Warner and Rutter, 2020; BPS, 2019; British HIV Association, 2018; BPS et al, 2011).

A diagnosis of HIV brings with it unique challenges such as discrimination, isolation and a lack of understanding, all of which can contribute to poor psychological wellbeing.

Mental health issues can significantly impact a person’s adjustment to their diagnosis, their relationships with healthcare providers, and their adherence to treatment. This, in turn, can lead to poorly controlled HIV and worse health outcomes.

Furthermore, poor mental health often disrupts sleep patterns and physical wellbeing, exacerbating psychological issues.

“Recognising mental health care as central to the HIV multidisciplinary team approach is crucial to ensuring we can support people living with HIV to achieve the best possible physical and mental health outcomes. We must equip HIV care providers with the knowledge to screen for psychological distress and support them to deliver psychologically informed care and onward referral with confidence.”

Sarah Rutter, clinical psychologist and psychology lead in the HIV Service at North Manchester General Hospital

There is room for improvement in current mental health and sleep assessments and interventions (Brown et al, 2022)

Recently, our team conducted market research involving 39 clinics who reported on data from 665 individuals living with HIV – the results clearly indicated that healthcare professionals are experiencing an increased demand for psychological wellbeing and mental health support services.

However, the research also highlighted significant variation in practice alongside a lack of guidance, resource and capacity to facilitate identification, management and ongoing monitoring of psychological wellbeing and sleep (Brown et al, 2022).

The findings indicate a deep need for improvements in this area since continuous monitoring and assessment are crucial if we are to enhance long-term health outcomes and improve quality of life for people living with HIV.

Enabling healthcare professionals to feel better informed and confident in the support they recommend

To bridge this gap and equip healthcare professionals with the necessary tools, skills, confidence and knowledge, the Gilead HIV Standards Support Team’s training programme provides an overview of existing relevant guidance, practical strategies for implementing current standards within clinical practice, information on common screening tools, available resources, and pathways for referrals related to psychological and sleep issues.

“Without the proper training and resource, it is not always possible for healthcare professionals to feel comfortable in providing mental health support to people living with HIV. If mental health needs are not addressed in our patient cohort, this can have detrimental effects on their health, their quality of life and HIV care. Helping care providers to understand common mental health issues present in HIV populations, the underlying causes of psychological distress, and the variety of support they can offer, is the first step in untangling this complex web. Combined with practical advice on how to screen and offer some emotional support to improve patients’ psychological wellbeing, these training modules aim to ensure that mental health is made a priority in HIV care.”

Dr Shimu Khamlichi, clinical psychologist, Royal Free Hospital London

If you are interested in finding out how you can help advance care in this area, speak to one of our HIV Standards Support Team regarding the training modules: HIVStandardsSupport@gilead.com

At Gilead, we believe that together, we can end the epidemic for everyone, everywhere.

UK-UNB-4284 | August 2023

References

British HIV Association (2018) Standards of Care for People Living with HIV. BHIVA.

British Psychological Society (2019) British Psychological Society response to the APPG on HIV and Mental Health in England. BPS.

British Psychological Society et al (2011) Standards of Psychological Support for Adults Living with HIV. BHIVA.

Brown A et al (2022) Psychological wellbeing and sleep in human immunodeficiency virus (HIV): a retrospective analysis of assessment and interventions within HIV services in the UK and Ireland (UKI).

Chaponda M et al (2017) Systematic review of the prevalence of psychiatric illness and sleep disturbance as co-morbidities of HIV infection in the UK. International Journal of STD & AIDS; 29: 704-713.

Croston M, Rutter S (2020) Psychological Perspectives in HIV Care: An Inter-professional Approach. Routledge.

Warner S, Rutter S (2020) Traumatic beginnings, complicated lives: attachment styles, relationships and HIV care. In: Croston M, Rutter S, eds. Psychological Perspectives in HIV Care: An Inter-professional Approach. Routledge.

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