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There is a clear need for effective strategies to address the factors that affect retention, or Lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and 1) LTFU or 2) Uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly-diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six-weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly-diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly-diagnosed HIV-infected women in Kinshasa, DRC.

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IntroductionVoluntary male medical circumcision (VMMC) is a safe, one-time intervention that provides up to 60% protection against HIV acquisition. Although this protection has led men in some communities to queue up for VMMC, in other places, including Malawi, demand remains low. Men report not undergoing VMMC fearing reduced sexual pleasure or performance, infections, bleeding, cosmetic unacceptability, and pain. VMMC can be a transformative intervention in high-HIV prevalence regions, if men decide to be circumcised. We assessed VMMC decision making during a longitudinal community-based cohort study of men and women in rural Malawi.MethodsThrough our Umoyo wa Thanzi (UTHA, Health for Life) research program in rural Lilongwe District, we interviewed reproductive-age women (n=308) and their male partners (n=140) using a standardised instrument. We assessed knowledge about VMMC for HIV risk reduction, and, drawing from the Theory of Planned Behaviour, we assessed attitudes toward VMMC, subjective norms about VMMC, and perceived behavioural control over VMMC.ResultsMost participants (77%) had heard about VMMC. More men (93%) than women (70%) had heard about VMMC, and more men (87%) than women (54%) knew about VMMC for HIV risk reduction. Only 6% of men reported being circumcised. Willingness to learn about VMMC was high (82%), with few participants expressing any concerns. Among male participants, a majority (70%) reported being willing to undergo VMMC. The main concern about undergoing VMMC was that it might hurt (16%). We found high willingness (69%) to undergo VMMC if it were recommended by a health care provider. Most men (71%) expressed confidence about being able to go to a health clinic for VMMC.ConclusionWhile earlier VMMC interventions were not successful in Malawi, our findings indicate that in some communities, many rural men have positive attitudes toward VMMC, would learn about and accept health care provider advice to undertake VMMC, and believe they are able to seek VMMC. VMMC should be considered a viable HIV prevention strategy in rural Malawi.