Depression and ART Initiation Among HIV Serodiscordant Couples in Kenya and Uganda

Velloza, Jennifer; Celum, Connie; Haberer, Jessica; Ngure, Kenneth; Irungu, Elizabeth; Mugo, Nelly; Baeten, Jared M.; Heffron, Renee

doi:10.1007/s10461-017-1829-z

Cited by 22 publications

(18 citation statements)

References 48 publications

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“…These findings differed from our expectations and are inconsistent with previous studies reporting that mental health problems could delay ART initiation [54, 55]. However, our findings are consistent with recent studies that demonstrated increased ART uptake among PLWH with depression or anxiety [22, 56]. Likely, these depressed and/or anxious PLWH were more concerned about their health status and were more likely to seek health services [22].…”

Section: Discussioncontrasting

confidence: 99%

Intention to initiate antiretroviral therapy (ART) among people living with HIV in China under the scaling-up of ART: the role of healthcare workers’ recommendations

et al. 2019

BMC Health Serv Res

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Background The early initiation of antiretroviral therapy (ART) for people living with HIV (PLWH) benefits both individuals and societies. However, little is known about the intention to initiate ART among PLWH in China in the context of a scaling-up of treatment or how the recommendations of healthcare workers affect this intention. Methods A total of 451 ART-naïve PLWH were recruited from communities in Guangzhou, China for this study. Data were collected by trained physicians via face-to-face interviews. Logistic regression models were fitted for the data analyses. Results Of the participants, 93.8% were male, 72.7% were infected via homosexual behaviour and 68.5% reported an intention to initiate ART. In the latter category, 77.8, 41.9 and 20.0% of respondents received strong recommendations to initiate ART from healthcare workers at the Centres for Disease Control and Prevention (CDC), community healthcare centres and non-governmental organisations (NGOs), respectively. After adjusting for potential confounders, depression, anxiety and strong recommendations from healthcare workers at the CDC and NGOs correlated significantly with ART intention. In the adjusted final hierarchical logistic regression model, the duration of infection [multivariate odds ratio (OR m ) = 0.30, p < 0.001], route of HIV infection (OR m = 0.18, p < 0.01), infection status of the current spouse/regular sex partner (OR m = 0.21–0.23, p < 0.01), anxiety (OR m = 2.44–2.65, p < 0.05) and strong recommendations from CDC physicians (OR m = 3.67, p < 0.01) or NGOs workers (OR m = 3.67, p < 0.01) were independently associated with the ART intention, whereas a recommendation from a community healthcare centre physician was not. Conclusions In Guangzhou, the prevalence of ART intention was below the 90–90-90 targets. Further studies aimed at an in-depth understanding and encouragement of health care workers’ perceptions regarding early ART are warranted as a means of scaling up new ART strategies.

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Section: Discussioncontrasting

confidence: 99%

Intention to initiate antiretroviral therapy (ART) among people living with HIV in China under the scaling-up of ART: the role of healthcare workers’ recommendations

et al. 2019

BMC Health Serv Res

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“…In South Africa, where linkage to care was defined as obtaining a CD4 count within 3 months of a positive HIV test, one study found no difference between those with and without depression at testing [53] and one found that those with depression were less likely to be linked to care [32]. In Kenya and Uganda, greater depressive symptom severity was associated with greater likelihood of ART initiation during the study period among sero-converted partners of previously sero-discordant couples [54]. Studies of depression and retention in care conducted in Malawi and the Democratic Republic of the Congo found no difference between 12-month retention or viral suppression among pregnant women with and without depression at ART initiation [20,55].…”

Section: Discussionmentioning

confidence: 99%

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

et al. 2020

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As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

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“…This finding is consistent with emerging research; for example, a longitudinal study conducted in Kenya (n = 162) similarly found that depressive symptom severity was associated with greater odds of ART initiation. 58 It is plausible that WLWH may seek health care because of depression, promoting ART initiation and maintenance, even while acting as a barrier to optimal ART adherence. Depression is common among people newly diagnosed with HIV 59 and may persist over time due in part to HIV-related stigma.…”

Section: Discussionmentioning

confidence: 99%

Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada

Logie¹,

Lacombe‐Duncan²,

Wang³

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Associations between HIV-related stigma and reduced antiretroviral therapy (ART) adherence are widely established, yet the mechanisms accounting for this relationship are underexplored. There has been less attention to HIV-related stigma and its associations with ART initiation and current ART use. We examined pathways from HIV-related stigma to ART initiation, current ART use, and ART adherence among women living with HIV in Canada.Methods:We used baseline survey data from a national cohort of women living with HIV in Canada (n = 1425). Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of HIV-related stigma dimensions (personalized, negative self-image, and public attitudes) on ART initiation, current ART use, and 90% ART adherence, and indirect effects through depression and HIV disclosure concerns, adjusting for sociodemographic factors.Results:In the final model, the direct paths from personalized stigma to ART initiation (β = −0.104, P < 0.05) and current ART use (β = −0.142, P < 0.01), and negative self-image to ART initiation (β = −0.113, P < 0.01) were significant, accounting for the mediation effects of depression and HIV disclosure concerns. Depression mediated the pathways from personalized stigma to ART adherence, and negative self-image to current ART use and ART adherence. Final model fit indices suggest that the model fit the data well [χ2(25) = 90.251, P < 0.001; comparative fit index = 0.945; root-mean-square error of approximation = 0.044].Conclusions:HIV-related stigma is associated with reduced likelihood of ART initiation and current ART use, and suboptimal ART adherence. To optimize the benefit of ART among women living with HIV, interventions should reduce HIV-related stigma and address depression.

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Depression and ART Initiation Among HIV Serodiscordant Couples in Kenya and Uganda

Cited by 22 publications

References 48 publications

Intention to initiate antiretroviral therapy (ART) among people living with HIV in China under the scaling-up of ART: the role of healthcare workers’ recommendations

Intention to initiate antiretroviral therapy (ART) among people living with HIV in China under the scaling-up of ART: the role of healthcare workers’ recommendations

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada

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