Likely clinical depression and HIV-related decline in antiretroviral therapy untreated women who seroconverted during participation in microbicide trials in sub-Saharan Africa

Abstract

Depression worsens HIV outcomes in populations treated with antiretroviral therapy (ART) medications. Data are limited on the relationship between depression and HIV in untreated populations in sub-Saharan Africa. We aimed to identify associations between likely clinical depression, alcohol use, social support by partners, and HIV viral load (VL) among ART untreated women who recently became HIV positive and enrolled in the Microbicide Trials Network (MTN)-015 study. Analyses used cross-sectional data collected at baseline in MTN-015. Participants in this analysis ( N = 190) enrolled from other MTN trials were not receiving ART and provided data on their HIV disclosure status to their husband or male partner and alcohol use behavior. The dependent variable, VL, was categorized as: low (≤400 RNA copies/mL; 9.1% of participants), medium (401–20,000 RNA copies/mL; 48.8%), and high (>20,000 RNA copies/mL; 42.0%). Depression was assessed using eight items from Hopkins Symptom Checklist; a cutoff of ≥1.75 indicated likely clinical depression. Independent variables with a significance of p ≤ 0.05 in unadjusted regressions were included in a regression adjusted for age, education, and time since seroconversion. Depressive symptoms were positively associated with high VL, in the adjusted regression (OR = 1.80; 95% CI = 1.07–3.01). Results suggest that likely having clinical depression may have a biological relationship with HIV disease progression.

Mental health burden among females living with HIV and AIDS in sub-Saharan Africa: A systematic review

“…Data on the prevalence of depression were published by Thirteen (13) studies (68.4%) [ 6 , 26 – 34 , 36 , 40 – 42 ]. According to the data that were retrieved, the prevalence of depressive symptoms varies from 5.9%, among HIV-positive women in Nigeria [ 34 ] to 61% among HIV-positive women in Uganda, [ 33 ] demonstrating the lowest to the highest depression symptomatology at different study locations.…”

“…Among the 19 studies that formally assessed anxiety and depression, 16 (84.2%) used standardized scales/measures while 3 (15.8%) used semi- structured interview guide [ 37 – 39 ]. Among the sixteen (16) studies, five (5) used the Center for Epidemiologic Studies Depression Scale (CES-D) [ 27 , 32 , 39 – 41 ], four used the Hopkins Symptom Checklist (HSCL-25) [ 26 , 30 , 33 , 36 ], three used the Patient Health Questionnaire-9 (PHQ-9) [ 31 , 42 ], Five studies used different scales thus, the Patient Health Questionnaire-2 (PHQ-2) [ 29 ], Beck’s Depression Inventory II (BDI-11) [ 34 ], Beck’s Depression index [ 35 ], the Hospital Anxiety and Depression Scale (HADS) [ 6 ], and the Emotional distress scale [ 28 ]. Most of the scales used were developed and validated in high income settings and therefore lacked contextual (cultural and non -specificity to the HIV population) validity.…”

“…Most of the scales used were developed and validated in high income settings and therefore lacked contextual (cultural and non -specificity to the HIV population) validity. The reliability coefficient of the scales was not reported in a majority of the studies (n = 11) [ 6 , 26 , 29 , 30 , 32 , 33 , 35 , 37 – 39 , 43 ].…”

“…In 11 of these studies [ 6 , 26 , 28 – 33 , 41 – 43 ], a univariate, multivariate or logistic regression analysis showed that sexual abuse, physical intimate partner violence, loneliness, enacted stigma, childhood trauma, post-traumatic stress disorder, young age, high viral load, having no formal education, divorce, unemployment and low social support increased the odds of depression and anxiety in FLWHA and was statistically significant (P ≤ 0.005). However, one study [ 36 ] showed there was no significant correlation (P ≥ 0.005) between depression/anxiety symptoms and educational status, employment status, and ART treatment status.…”

“…Data on the impact of HIV/AIDS on mental health outcomes of FLWHA was gathered from seven (n = 7) studies representing 36.8% [ 6 , 26 , 27 , 34 , 37 , 39 , 41 ] from four countries with relatively different sample characteristics. Among these studies, HIV/AIDS was projected as a significant correlate for depression and anxiety.…”