Abstract summary 

Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The nine-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH.five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal and the Republic of Congo.Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity, and area under the curve (AUC)) of the traditional PHQ-9 scoring (positive screening - score≥10) was compared to alternative scoring algorithms including: i) the presence of ≥1 mood symptom (PHQ-9 items 1&2) combined with ≥2 other symptoms listed in the PHQ-9, and ii) a simplified recoding of each 4-response item into two categories (absence/presence).A total of 735 participants were included (54% female, median age 42 years [IQR 34-50]). Depression was diagnosed by a psychiatrist in 95(13%) participants. Alternative scoring sensitivities (0.59 to 0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC were significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability.As a primary screening test, new scoring algorithms appeared to improve the PHQ-9 sensitivity in identifying depression and reduce heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.

Authors & Co-authors:  Bernard Charlotte C Font Hélène H Zotova Natalia N Wools-Kaloustian Kara K Goodrich Suzanne S Kwobah Edith Kamaru EK Awoh Ajeh Rogers AR Nko'o Mbongo'o Guy Calvin GC Nsonde Dominique Mahambu DM Gandou Paul P Minga Albert A Tine Judicaël Malick JM Ndiaye Ibrahima I Dabis François F Seydi Moussa M de Rekeneire Nathalie N Yotebieng Marcel M Jaquet Antoine A

Study Outcome 

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