Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Mental disorder and the outcome of HIV/AIDS in low-income and middle-income countries: a systematic review Rosie Mayston a , Eugene Kinyanda b , Nathaniel Chishinga c,d , Martin Prince a and Vikram Patel e Objectives: To conduct a systematic review of the literature to examine the inter- relationship between mental health and treatment outcomes in low-income and middle-income settings; to update the work of Collins et al. (2006). Design: Systematic review of peer-reviewed articles that examined one of the follow- ing: the effects of mental disorders (including cognitive impairment) upon engagement with treatment and/or adherence; their influence upon HIV-related clinical outcomes; and the impact of interventions for mental disorder. Methods: Articles about mental health and HIV/AIDS were included if they were published after 2005 and addressed one of the areas of interest described above. Systematic methods were used for searching, screening, and data extraction. Studies employing quantitative measures of exposures and outcomes wherein all participants had a diagnosis of HIV/AIDS were included. Results: This review found ample and moderately consistent evidence that adverse mental health and alcohol consumption are associated with reduced adherence. Variation in measurement and the relative paucity of work meant that interpretation of studies examining engagement with care and other clinical outcomes was difficult. Evidence on the efficacy and effectiveness of mental health interventions in low-income and middle-income settings was very limited. Conclusion: This review suggests that psychosocial factors, namely, depression and alcohol may have adverse effects upon HIV-related outcomes. However, further large, high-quality studies examining outcomes other than adherence are needed. There is also an urgent need for randomized controlled trials of interventions for mental disorder and a need to investigate their impact upon HIV-related outcomes. ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2012, 26 (Suppl 2):S117–S135 Keywords: adherence, alcohol, depression, engagement with services, low and middle income settings, mental health interventions Introduction In high-income, low HIV prevalence settings, research has shown that the prevalence of mental disorder among people living with HIV/AIDS is high (i.e., [1,2]) and that poor mental health has adverse effects upon disease progression and mortality [3], as well as on adherence to antiretroviral therapy (ART) [4]. This has led to the widespread provision of specialist mental health services for people at-risk or living with the disease, with the a Centre for Global Mental Health and Health Service & Population Research Department, Institute of Psychiatry, King’s College London, UK, b MRC/UVRI Uganda research Unit on AIDS, Entebbe, Uganda & Senior EDCTP Fellowship, Cape Town, South Africa, c Zambia AIDS-related TB Project, School of Medicine, Ridgeway Campus, Lusaka, Zambia, d Department of Clinical Research, and e Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK. Correspondence to Rosie Mayston, PO Box 30, Health Service & Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF. Received: 13 December 2011; accepted: 25 October 2012. DOI:10.1097/QAD.0b013e32835bde0f ISSN 0269-9370 Q 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins S117