The HIV Mental Health Research Unit (HIV MHU) first received accreditation in 2014. This followed a huge clinical and research impetus in the area of HIV and mental health to address the needs of persons living with HIV (PLWH) and severe mental illness (SMI). These were the days of early and limited antiretroviral access, and persons with SMI and HIV were often stigmatized, falling “between the clinical cracks”.
In response to this stimulus, and the growing recognition of the burden of common mental disorders in PLWH such as depressive, anxiety, substance abuse and neurocognitive disorders, the HIV MHU built on this platform to develop a programme of clinical service, teaching and research relevant to the field of HIV and mental health.
At the time of accreditation, the HIV MHU was developing niche expertise in both adult and adolescent mental health. Since then, it has become clearer that the neurobiology of HIV-associated brain disease (leading on the one hand to cognitive disorders), and the psycho-social and behavioural aspects, were linked thematically. And so, the Unit conducts research across the life-span in PLWH, and with a focus on the neurobiology of HIV-brain disease, as well as behavioural consequences and treatments.
The Unit has become a highly productive body, supported by strong local and international collaborations.
Vision and mission
The overall aim of the HIV MHU is to improve the mental health and well-being of persons living with HIV. Our investigations include understanding mechanisms and interventions in mental disorders associated with HIV; as well as behavioural pathways and outcomes in PLWH. Our guiding principle is to develop an evidence base to extend the provision of effective mental health services to persons living with HIV with a focus on South Africa and other resource-limited settings.
Research Agenda
Our research agenda remains focussed on the HIV Mental Health matrix of youth and adults impacted by HIV, through the lens of behavioural and neuroHIV methods. We are in process of investigating the following:
(1) youth impacted by HIV and its effects on brain function,
(2) interventions to improve outcomes in TB-infected smokers,
(3) implementation of an integrated alcohol treatment program in HIV care,
(4) multi-dimensional clustering methods to identify unique phenotypes of youth HIV based on interactions between viral, immunological and psycho-social risk factors, and
(5) the impact of substance abuse on systemic inflammation and viral reservoir in youth living with HIV
The issue of HIV and its bio-behavioural effects remains a critical public health concern both in South Africa, but also across other low and middle income countries. Lessons learnt from our work may be translated into practice across other key public mental health domains. These include HIV as an exemplar of a chronic disease, both in terms of adherence but also in terms of its neuro- behavioural effects. We have also developed significant expertise in health systems strengthening in terms of intervention development and delivery, and this has applications across multiple conditions.
Leadership
The Unit is led by Prof John Joska (director) and Prof Jackie Hoare (co-director). The leadership team has developed a strong alliance and complementary functions, through links to Neuropsychiatry (Joska) and Liaison Psychiatry (Hoare), as well as through the coalescing of research groups around Adults (Joska) and Adolescents (Hoare). Many NI members form part of this Unit.