Risk factors for HIV virological non‐suppression among adolescents with common mental disorder symptoms in Zimbabwe: a cross‐sectional study

Abstract

Introduction Adolescents are at increased risk of HIV virological non‐suppression compared to adults and younger children. Common mental disorders such as anxiety and depression are a barrier to adherence and virological suppression. The aim of this study was to identify factors associated with virological non‐suppression among adolescents living with HIV (ALWH) in Zimbabwe who had symptoms of common mental disorders. Methods We utilized baseline data from a cluster‐randomized controlled trial of a problem‐solving therapy intervention to improve mental health and HIV viral suppression of ALWH. Sixty clinics within 10 districts were randomized 1:1 to either the intervention or control arm, with the aim to recruit 14 adolescents aged 10 to 19 per clinic. Adolescents were eligible if they scored ≥7 on the Shona Symptom Questionnaire measuring symptoms of common mental disorders. Multivariable mixed‐effects logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with non‐suppression, defined as viral load ≥1000 copies/mL. Results Between 2 January and 21 March 2019 the trial enrolled 842 participants aged 10 to 19 years (55.5% female, 58.8% aged <16). Most participants (N = 613) were taking an NNRTI‐based ART regimen (13 PI‐based, 216 unknown) and median duration on ART was six years (IQR three to nine years, 240 unknown). Of the 833 with viral load data 292 (35.1%) were non‐suppressed. Virological non‐suppression was independently associated with male sex (adjusted OR (aOR) = 1.43, 95% CI 1.04 to 1.97), and with not knowing one’s own HIV status (aOR = 1.77, 95% CI 1.08 to 2.88), or knowing one’s status but not disclosing it to anyone (aOR = 1.99, 95% CI 1.36 to 2.93), compared to adolescents who knew their status and had disclosed it to someone. Conclusions ALWH with symptoms of common mental disorders have high prevalence of virological non‐suppression in Zimbabwe, especially if they do not know their status or have not disclosed it. In general adolescents should be informed of their HIV status, with encouragement on the beneficial health and social effects of viral suppression, to incentivise adherence. Efforts to strengthen the operationalization of disclosure guidelines for adolescents should now be prioritized.

Predictors and Timing to Viral Suppression in HIV-Infected Pregnant Women in the University of Zimbabwe Birth Cohort Study During the Era of Lifelong Antiretroviral Therapy (Option B+ Treatment Strategy)

“…Self-reported depression was rare in our cohort (1.5% of all HIVinfected mothers); however, depression was associated with the highest likelihood among all predictors for not achieving VS among women on ART (OR 0.092, corresponding to a 10.8fold higher likelihood of not being virally suppressed). In line with these observations, mental disorders have previously been described as barriers to efficient HIV therapy in Zimbabwean adolescents (51).…”

“…In a South African study of women with a new HIV diagnosis during pregnancy and immediate initiation of ART, disclosure of HIV status to their spouses/intimate partner was associated with a reduced risk of detectable VL >50 copies/ml at delivery (29). Conversely, non-disclosure of HIV status has also been associated with decreased odds for VS in Ugandan pregnant women initiating lifelong ART (57,58) and Zimbabwean adolescents with mental disorders (51). This points to HIV-related stigma as possibly one reason for reduced rates of ART adherence.…”

Behavioral and emotional difficulties and HIV treatment outcomes among HIV-infected children in rural southwestern China

“…This result was consistent with previous studies, which showed that females were roughly 2.50 times more likely to experience virological failure than males [ 44 , 45 ]. However, other previous studies reported either a higher risk of virological failure in males [ 43 ], or no association between gender and virological failure [ 39 , 42 ]. The inconclusive result on this association needs to be further assessed in large and diverse samples in future studies.…”

“…Some previous studies also found that older children had a higher risk of virological failure [ 39 , 40 ], which could be explained by the poorer adherence and higher likelihood of drug resistance in older children [ 39 , 41 ]. Future studies are still needed to further testify this association and verify the reasons between age and virological failure because other previous studies did not detect this association [ 42 , 43 ]. In this study, females were 2.21 times more likely to experience virological failure compared to males.…”

From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV

“…Mental health distress is in turn a key driver of adolescent disengagement with HIV health services, ART non-adherence, unsuppressed viral load and unsafe sex, 28 exacerbated by low levels of disclosure. 29 HIV is a lifelong infection, and there may be particular periods of heightened vulnerability-such as testing, disclosure and transitioning from paediatric into adult HIV care. Emerging evidence suggests that COVID-19 has increased adolescent mental health challenges globally, through interrupting care access 30 and education, 31 and increasing poverty and violence against children.…”