Introduction
Methods
Study population and procedures
Ethics
Procedures
Outcomes
Statistical and qualitative analysis
Results
Study population
Total N (%) | GAD-7 ≥ 10 n (%) | GAD-7 < 10 n (%) | p-value | |
---|---|---|---|---|
N (%) | 167 | 41 (24.6) | 126 (75.4) | – |
Median age in years (IQR) | 44 (40–50) | 43 (40–49) | 45 (40–50) | 0.8 |
Gender | ||||
Cisgender men | 66 (39.5) | 17 (41.5) | 49 (38.9) | 0.3 |
Cisgender women | 100 (59.9) | 23 (56.1) | 77 (61.1) | |
Transgender woman | 1 (0.6) | 1 (2.4) | 0 | |
Monthly household income (USD) | ||||
< 65 | 35 (20.9) | 11 (26.8) | 24 (19.0) | 0.6 |
65–130 | 64 (38.3) | 14 (34.1) | 50 (39.6) | |
131–199 | 36 (21.6) | 10 (24.4) | 26 (20.6) | |
≥ 200 | 32 (19.2) | 6 (14.6) | 26 (20.6) | |
Education | ||||
No formal education | 22 (13.2) | 4 (9.8) | 18 (14.3) | 0.4 |
≤ 9 years | 74 (44.3) | 22 (53.7) | 52 (41.3) | |
> 9 years | 71 (42.5) | 15 (36.6) | 56 (44.4) | |
Employment prior to lockdown a | ||||
Unemployed | 33 (19.8) | 9 (21.9) | 24 (19.0) | 0.5 |
Informal sector | 95 (56.9) | 25 (61.0) | 70 (55.6) | |
Salaried | 39 (23.3) | 7 (17.1) | 32 (25.4) | |
Living with a spouse | ||||
Yes | 83 (49.7) | 19 (46.3) | 64 (50.8) | 0.7 |
No | 84 (50.3) | 22 (53.7) | 62 (49.2) | |
Median duration on ART in years (IQR) | 9.8 (6.5–12.9) | 9.5 (6.7–11.8) | 9.9 (6.4–13.1) | 0.4 |
Latest CD4 counts (cells/mm3) | ||||
< 500 | 44 (26.4) | 10 (24.4) | 34 (26.9) | 0.8 |
≥ 500 | 57 (34.1) | 13 (31.7) | 44 (34.9) | |
Do not know | 66 (39.5) | 18 (43.9) | 48 (38.1) | |
Latest viral load | ||||
Undetectable (< 50 copies/mL) | 87 (52.1) | 16 (39.0) | 71 (56.3) | 0.1 |
≥ 50 copies/mL | 9 (5.4) | 3 (7.3) | 6 (4.8) | |
Do not know | 71 (42.5) | 22 (53.7) | 49 (38.9) | |
Prior history of tuberculosis | ||||
Yes | 64 (38.3) | 19 (46.3) | 45 (35.7) | 0.3 |
No | 103 (61.7) | 22 (53.7) | 81 (64.3) | |
Living with another comorbidity b | ||||
Yes | 45 (27.0) | 12 (29.3) | 33 (26.2) | 0.7 |
No | 122 (73.0) | 29 (70.7) | 93 (73.8) | |
Median days of remaining ART (IQR) | 60 (28–76) | 32 (17–60) | 60 (30–79) | 0.05 |
Discontinued ART during the lockdown | 5 (3.3) | – | – | – |
Prevalence of anxiety
Causes of anxiety
Theme a: concerns associated with the immediate present
“I have low CD4 counts and I am also taking medicines for tuberculosis. I am scared that I will get infected with coronavirus.” (cisgender man, GAD-7 score: 2)
Immediate non health-related concerns centered around financial insecurity resulting from unemployment and a lack of savings and predominantly drove apprehensions about food security, eviction, and the ability to provide for the family.“I have low immunity because of HIV, I am worried of getting COVID-19 infection. I feel that even a common cold could be coronavirus.” (cisgender woman, GAD-7 score: 10)
“I am a construction worker. I am at home with my two children. My wife is dead. Currently I am worried about how the house will run as there is no money and no work.” (cisgender man, GAD-7 score:12)
“As the only earning member of my family, I am worried. My children are young. We are doing whatever it takes to get by, but because of the lockdown I am unemployed now. The house is rented. I cannot return to my village either.” (cisgender man, GAD-7 score: 6)
“There is no food at home currently and I cannot feed my children. I am a housewife and I have no income or savings. The children used to earn by washing cars.” (cisgender woman, GAD-7 score: 10)
Theme B: concerns associated with the imminent future
“I work as a care counsellor in the ART center. There are no coronavirus patients at this time point, but I am worried what will happen if they visit the center in the future?” (cisgender man, GAD-7 score: 1)
Imminent non health-related concerns included fears about shortages of opportunities for gainful employment or dismissal from current employment and fed into anxieties about an uncertain future that such eventualities would ensue. Such fears often co-existed with an anticipation for “normality”.“I am scared to return to get my medicines at the ART center after the lockdown, if coronavirus does not end. Coronavirus must end.” (cisgender woman, GAD-7 score: 5)
“I am a sex worker. My business is closed and I have no clients because of the lockdown. I will die of hunger if the virus continues. I am worried all the time. If coronavirus doesn't end, then what?” (cisgender woman, GAD-7 score: 5)
“I am going to lose my job because of this lockdown. I am eager to know when will COVID-19 end, when will we go back to normal life?” (cisgender woman, GAD-7 score: 9)
“I stay with my mother and sold fruits for a living. Now that has closed, and I don’t know when I will be able to start again. When will COVID-19 end? When can we start normal life?” (cisgender woman, GAD-7 score: 12)
Theme C: lack of social and financial support
“I stay alone. I used to run a beauty salon that I rented, which is now closed. I have no money to pay the owner who is asking for rent. I have no savings and no one to talk to. I have a lot of tension and I feel lonely.” (cisgender woman, GAD-7 score: 21)
This theme was also common among migrant workers from outside or within the state.“I stay alone. My daughter is recently married. I worked in a company, but it has closed. I have no salary and I stay in a rented house. I receive no help from my in-laws who stay in the same neighborhood.” (cisgender woman, GAD-7 score: 10)
“My family is in Bihar (a state 900 miles to the east). I want to go home, but I can't. There is a lot of tension and I worry a lot. I have no work and no money now.” (cisgender male, GAD-7 score: 21)
Theme D: indifference to circumstances secondary to COVID-19
“I work in the fields. There is no coronavirus there. Everything is fine.” (cisgender man, GAD-7 score: 0)
“Now, I have work on the sewing machine, and I am not worried at all.” (cisgender woman, GAD-7 score: 0)
“I do not get out of the house and I am not worried at all.” (cisgender woman, GAD-7 score: 0)