The Associations between Mental Health Literacy and HIV-related Treatment Outcomes among HIV/AIDS Outpatients in Vietnam

Download Article

DOI: 10.21522/TIJPH.2013.10.02.Art008

Authors : Thanh Nguyen Tat, Dat Nguyen Tat


Data about mental health literacy and its associations with HIV-related treatment outcomes are both sparsely reported and presented with disparate results. This study aimed to assess the mental health performance among HIV/AIDS outpatients and examine the correlations between Mental Health Literacy Scale (MHLS) with some pre-specified HIV-related treatment outcomes, including clinical status, HIV-RNA suppression, antiretroviral (ART) failure, and treatment adherence. We conducted a single-center, cross-sectional study between June and October 2020 in Ho Chi Minh City, Vietnam. Adult HIV-infected patients were enrolled in the study when they routinely attended an outpatient clinic to receive medical consultations and antiretroviral therapy. Bivariate logistic regressions were used to study the associations between MHLS and major HIV-related health outcomes. A total of 406 HIV-infected participants were enrolled during the study period. The median MHLS among HIV/AIDS patients was 99 (Interquartile range (IQR): 93-107). Roughly 93% of patients were clinically stable, with a median CD4 count of 603 cells/µl. Two-thirds of patients achieved HIV-RNA suppression (undetectable threshold < 20 copies/ml). A total of thirteen (3.2%) patients were undertaking protease-inhibitors-based second-line ART regimens. The ART compliance of participants was evaluated at 92.1%. The logistic bivariate analyses did not show any significant correlations between mental health literacy with both pre-specified HIV-related health outcomes and ART adherence. The mental health performance among the HIV/AIDS outpatients at the HIV community-based clinic was at the intermediate level. The mental health literacy of patients was not statistically associated with the pre-specified HIV treatment outcomes.

Keywords: Adherence, Antiretroviral therapy, HIV treatment outcomes, Mental health literacy, Vietnam.


[1] Global HIV and AIDS statistics | Avert 2020. [Internet]. Available from: [(Accessed and cited on 12 March 2021].

[2] World Health Organization. Transition to new antiretroviral drugs in HIV programmes: clinical and programmatic considerations. Geneva: 2017. [Internet]. [Accessed and cited on 20 June 2021]. Available from:

[3] WHO report 2018 on the Dolutegravir program. [Internet]. [(Accessed and cited on 20 June 2021]. Available from:

[4] Dorward J, Lessells R, Drain PK, Naidoo K, de Oliveira T, Pillay Y, et al. Dolutegravir for first-line antiretroviral therapy in low-income and middle-income countries: uncertainties and opportunities for implementation and research. Lancet HIV. 2018; 5: e400-e404.

[5] Organization WH. Depression and other common mental disorders: global health estimates. In: World Health Organization. 2017. [Internet]. [Accessed and cited on 27 June 2021]. Available from:

[6] Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008; 70:539-45.

[7] Pence BW, Miller WC, Gaynes BN, Eron JJ. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007; 44: p. 159–66.

[8] Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC, Richardson JL, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004; 94: p.1133–40. PMID.

[9] Hicks G, Barragan M, Franco-Paredes C, Williams MV, del Rio C. Health literacy is a predictor of HIV/AIDS knowledge. Fam Med. 2006; 38:717-23.

[10] Jones D, Cook R, Rodriguez A, Waldrop-Valverde D. Personal HIV knowledge, appointment adherence, and HIV outcomes. AIDS Behav. 2013; 17:242-9.

[11] Kalichman SC, Pope H, White D, Cherry C, Amaral CM, Swetzes C, et al. Association between health literacy and HIV treatment adherence: further evidence from objectively measured medication adherence. J Int Assoc Physicians AIDS Care (Chic). 2008; 7:317-23.

[12] Murphy DA, Lam P, Naar-King S, Robert Harris D, Parsons JT, Muenz LR, et al. Health literacy and antiretroviral adherence among HIV-infected adolescents. Patient Educ Couns. 2010; 79:25-9.

[13] Navarra AM, Neu N, Toussi S, Nelson J, Larson EL. Health literacy and adherence to antiretroviral therapy among HIV-infected youth. J Assoc Nurses AIDS Care. 2014; 25:203-13.

[14] Wawrzyniak AJ, Ownby RL, McCoy K, Waldrop-Valverde D. Health literacy: impact on the health of HIV-infected individuals. Curr HIV/AIDS Rep. 2013;10: 295-304.

[15] Colbert AM, Sereika SM, Erlen JA. Functional health literacy, medication-taking self-efficacy, and adherence to antiretroviral therapy. J Adv Nurs. 2013; 69:295-304.

[16] Paasche-Orlow MK, Cheng DM, Palepu A, Meli S, Faber V, Samet JH. Health literacy, antiretroviral adherence, and HIV-RNA suppression: a longitudinal perspective. J Gen Intern Med. 2006; 21:835-840.

[17] Nelsen A, Trautner BW, Petersen NJ, Gupta S, Rodriguez-Barradas M, Giordano TP, et al. Development and validation of a measure for intention to adhere to HIV treatment. AIDS Patient Care STDS. 2012; 26:329-34.

[18] Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, et al. Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr. 2013; 63:42-50.

[19] O’Connor M, Casey L. The Mental Health Literacy Scale (MHLS): A new scale-based measure of mental health literacy. Psychiatry Res. 2015; 229 (1-2):511-516.

[20] Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents, and children. [Internet]. [Accessed and cited on 20 June 2021]. Available from:

[21] Nejatian M, Tehrani H, Momeniyan V, Jafari A. A modified version of the mental health literacy scale (MHLS) for Iranian people. BMC Psychiatry. 2021; 21:53.

[22] Chung MH, Chen LK, Peng LN, Chi MJ. Development and validation of the health literacy assessment tool for older people in Taiwan: potential impacts of cultural differences. Arch Gerontol Geriatr. 2015; 6:289-95.

[23] Kim YS, Lee HY, Lee MH, Simms T, Park BH. Mental health literacy in Korean older adults: A cross-sectional survey. J Psychiatr Ment Health Nurs. 2017; 24:523-533.

[24] Duong VT, Lin IF, Sorensen K, Pelikan JM, Van Den Broucke S, Lin YC, et al. Health Literacy in Taiwan: A Population-Based Study. Asia Pac J Public Health. 2015; 27: 871-80.

[25] Chen S, Chen K, Wang S, Wang W, Li Y. Initial Validation of a Chinese version of the Mental Health Literacy Scale Among Chinese Teachers in Henan Province. Front Psychiatry. 2021; 12:661903.

[26] Korhonen J, Axelin A, Grobler G, Lahti M. Content validation of Mental Health Literacy Scale (MHLS) for primary health care workers in South Africa and Zambia ─ a heterogeneous expert panel method. Glob Health Action. 2019; 12:1668215.