Depression, retention in care, and uptake of PMTCT service in Kinshasa, the Democratic Republic of Congo: a prospective cohort

Abstract

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.

Association between depressive symptoms and adherence among adolescents living with HIV in the Republic of Congo

“…The choice of PHQ-9 was motivated by the fact that Lingala translation was readily available from a study among pregnant women in the neighboring Kinshasa region. [ 14 ] PHQ-9 includes the nine items from the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) used in the diagnosis of depression. Each item is assigned a score ranging from 0 to 3 depending on the presence and duration of each symptom in the past two weeks: 0 if the symptom was never present, 1 if it had been present several days of the week, 2 if it had been present more than half the time, and 3 if it had been present almost every day.…”

“…Each item is assigned a score ranging from 0 to 3 depending on the presence and duration of each symptom in the past two weeks: 0 if the symptom was never present, 1 if it had been present several days of the week, 2 if it had been present more than half the time, and 3 if it had been present almost every day. Based on the sum of these scores, depressive symptoms are classified as insignificant (score of 0–4), mild, [ 5 – 9 ] moderate, [ 10 – 14 ] moderately severe [ 15 – 19 ] or severe. [ 20 – 27 ] In the present study, participants with PHQ-9 score ≥9 were classified as having symptoms suggestive of depression.…”

Postpartum Depression and Prevention of Mother-to-Child Transmission of HIV in Kenya

“…People living with HIV (PLWH) are more likely to experience depression than uninfected people (Boarts, Buckley-Fischer, Armelie, Bogart, & Delahanty, 2009; Endeshaw et al, 2014; Nyirenda, Chatterji, Rochat, Mutevedzi, & Newell, 2013). Several individual studies and meta-analyses link depression to adverse HIV-related outcomes among PLWH, including lower antiretroviral therapy (ART) uptake, lower ART adherence and reduced overall health status (Boarts et al, 2009; Endeshaw et al, 2014; Kingori, Haile, & Ngatia, 2015; Yotebieng, Fokong, & Yotebieng, 2017). Few studies have assessed the relationship of postpartum depression (PPD) among mothers living with HIV and prevention of mother-to-child HIV transmission (PMTCT) outcomes beyond the uptake of services and breastfeeding practices (Hartley et al, 2010; Tuthill, Pellowski, Young, & Butler, 2017; Yotebieng et al, 2017).…”

“…Several individual studies and meta-analyses link depression to adverse HIV-related outcomes among PLWH, including lower antiretroviral therapy (ART) uptake, lower ART adherence and reduced overall health status (Boarts et al, 2009; Endeshaw et al, 2014; Kingori, Haile, & Ngatia, 2015; Yotebieng, Fokong, & Yotebieng, 2017). Few studies have assessed the relationship of postpartum depression (PPD) among mothers living with HIV and prevention of mother-to-child HIV transmission (PMTCT) outcomes beyond the uptake of services and breastfeeding practices (Hartley et al, 2010; Tuthill, Pellowski, Young, & Butler, 2017; Yotebieng et al, 2017). Even fewer data are currently available on PPD and PMTCT outcomes among mothers living with HIV in low and middle-income countries (LMICs; Hartley et al, 2010; Tuthill et al, 2017; Yotebieng et al, 2017).…”

Probable antenatal depression at antiretroviral initiation and postpartum viral suppression and engagement in care

“…Probable antenatal depression at ART initiation did not appreciably affect postpartum engagement in care. Similarly, a study of women living with HIV in the Democratic Republic of the Congo (DRC) evaluated visit attendance at 6 weeks postpartum found no difference in visit attendance by antenatal depression status [40]. Although depression is widely cited as a barrier to engagement in HIV care [16], [41]–[46], the relationship of probable antenatal depression with engagement in care has not been quantified outside of the DRC study and the current study, which also includes viral load data.…”