Screening for attention-deficit/hyperactivity disorder traits among adults living with HIV or taking pre-exposure prophylaxis in Switzerland: a cross-sectional survey nested within the Swiss HIV Cohort Study and SwissPrEPared - a study protocol
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Introduction
People living with HIV experience disproportionately high rates of mental health conditions, yet adult attention-deficit/hyperactivity disorder (ADHD) is largely absent from the HIV literature. Traits associated with ADHD, together with social exclusion, adverse life events, stigma, and barriers to accessing healthcare may increase vulnerability to HIV acquisition and complicate adherence to treatment and prevention, and a comparable pathway may apply to users of HIV pre-exposure prophylaxis (PrEP). Prevalence data on ADHD in people living with HIV are limited to two small-scale studies, and no data exist for PrEP users. The objective of this study is to estimate the prevalence of ADHD traits among people living with HIV and PrEP users in Switzerland and to describe sociodemographic, behavioural and clinical patterns. The study was co-created and is co-led by people who, beyond their academic and clinical practices, have experiential knowledge of the topics being explored
Methods and analysis
This is a multicentre cross-sectional survey using a Critical ADHD Studies framework and nested within the Swiss HIV Cohort Study (SHCS) and SwissPrEPared cohort. Over a 12-month recruitment period, participants attending routine visits at participating sites will complete the six-item Adult ADHD Self-Report Scale Screener (ASRS-5). A positive screen is defined as a weighted score of 14 or higher. Three additional items capture the presence of traits in childhood before the age of 12, any previously established ADHD diagnosis, and the participant’s wish to receive their score and/or a follow-up consultation with a psychologist or psychiatrist. Screening data will be linked to routinely collected cohort variables. The primary objective is to estimate the prevalence of a positive ASRS-5 screen, with 95% Wilson score confidence intervals, in each cohort. Secondary objectives include comparing cohorts and examining associations between ADHD traits and substance use, sexual behaviour, sexually transmitted infections, depression and anxiety, treatment and prevention adherence, use of and interest in long-acting HIV treatment modalities, and gender identity and sexual orientation. A target sample of 800 participants per cohort was calculated for a 3% prevalence margin of error.
Ethics and dissemination
The study is nested within the SHCS and SwissPrEPared and falls under their existing ethical approvals and general participant consent. Participants who screen positive and wish to be followed up will be offered a consultation with an ADHD-experienced psychologist or psychiatrist. Results will be publicly available on the study website, published in peer-reviewed journals, and shared with participants and communities through lay summaries and cohort communication channels.
STRENGTHS AND LIMITATIONS OF THIS STUDY
The first study to systematically estimate the prevalence of ADHD traits at scale among people living with HIV and among users of HIV pre-exposure prophylaxis (PrEP).
Systematic administration to all participants attending routine visits, embedded in existing cohort workflows, limiting self-selection and reducing participation bias.
Linkage to rich, routinely collected cohort data allowing exploration of a broad range of sociodemographic, behavioural, and clinical correlates at scale.
The ASRS-5 identifies ADHD traits rather than making a clinical diagnosis; the study therefore estimates screening-positive trait prevalence, expected to exceed the possible prevalence of ADHD diagnoses, as in the general population.
Differences in questionnaire administration between cohorts (provider-administered in the SHCS versus self-administered in SwissPrEPared) and incomplete harmonisation of some variables may limit between-cohort comparability, resulting in cohort-stratified analyses instead.
