The Role of Depression in Retention in Care for Persons Living with HIV

Abstract

Individuals infected with HIV experience high rates of depression when compared to their sero-negative counterparts. Although symptoms of depression have been consistently linked to poor medication adherence among persons living with HIV/AIDS, their relation to retention in care are less well-known. The purpose of this study was to examine whether clusters of depressive symptoms influence retention in care and if so, whether these clusters had different relations to retention in care. This is a secondary data analysis of a larger study that investigated the role of health literacy, cognitive impairment, and social determinants on retention in HIV care. Individuals with HIV were recruited from South Florida from August 2009 to May 2011. A total of 210 participants were included in the current analyses. A measure of visit constancy was calculated to represent the number of 4-month intervals with at least one kept visit. Individual items on the Center for Epidemiological Studies Depression Scale short form (CES-D10) and factor analysis of the CES-D10 were independent variables. Overall, there was a high prevalence of depressive symptoms in the study participants. Furthermore, factor analysis showed that certain clusters of depressive symptoms were significantly associated with visit constancy. Specifically, negative mood/somatic symptoms were associated with a greater odds of missing a visit in any of the observed 4-month time periods than positive mood factor. Those patients reporting somatic symptoms and negative mood may need additional intervention and support to be effectively retained in care and successfully follow through with appointments and care.

CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study

“…Close follow up of PLH during the NAMWEZA intervention could have prompted more clinic visits and greater adherence to ART by exposed participants compared to unexposed group participants. Furthermore, the intervention addressed psychosocial concerns which have been reported to hinder adherence to ART and retention in care [21]. This is similar to what was observed in Zimbabwe and Zambia where a psychosocial intervention known as “mothers2mothers” (m2m) was found to improve retention and adherence to the Option B+ antiretroviral regimens among HIV infected women [39, 40].…”

“…Some of the factors reported to contribute to LTFU from ART care in Tanzania include individual factors such as advanced clinical and immunological disease stage, younger age, malnutrition, low education, depression, and poor psychological support [17–21]. The World Health Organization (WHO) reported other individual risk factors for LTFU from ART care commonly reported from resource-limited countries, including feeling better, pill burden, treatment fatigue, work as well as home responsibilities, and migration—mobile populations (‘silent transfers’)—to other ART service providers [22].…”

“…In particular, those that influence psychological factors that have been reported to predict HIV risk behaviors, poor adherence, low retention and poor treatment outcomes among PLH [26]. Providing psychological counselling, offering psychoeducation, facilitating psychosocial support and providing support to PLH to reduce psychosocial challenges including depression, anxiety, relationship/family turmoil and poor communication have been reported to increase adherence to ART [21, 27–30]; however, not much has been reported on how psychosocial interventions may impact LTFU and other HIV treatment outcomes in Tanzania.…”

HIV and ageing

“…56 Depression has been linked to reduced retention in care 57 and reduced cognitive performance. 58 Traditionally, depression has been associated with stigma in HIV-infected populations.…”

“…77 As people age with HIV beyond 65 years of age we will likely see substantially more cognitive dysfunction with consequence for HIV care, including lower adherence to ART 78 and reduced retention. 57,58 Alzheimer’s disease and vascular dementia will likely play an increasing role.…”