Depression at Treatment Initiation Predicts HIV Antiretroviral Adherence in Uganda

Published in: Journal of the International Association of Providers of AIDS Care, 2016

Posted on RAND.org on December 08, 2016

by Glenn Wagner, Mary Ellen Slaughter, Bonnie Ghosh-Dastidar

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Research Questions

  1. How does the severity or type of depression affect adherence to antiretroviral therapy (ART) for HIV?
  2. Are changes in depression symptoms associated with changes in ART adherence?

We examined the relationship between depression (symptom type, diagnostic severity, and change over time) and adherence to HIV antiretroviral therapy (ART) with data from 3 longitudinal studies (N = 1021) of patients starting ART in Uganda. The Patient Health Questionnaire was used to assess depressive symptoms (total score; somatic and cognitive subscales) and categorize severity level. At baseline, 9% had major depression and 30% had minor depression; 82% were adherent (reported no missed ART doses in the past 7 days) at month 6 and 85% at month 12. Controlling for demographic and medical covariates, multivariate random-effects logistic regression models revealed that change in depression was not related to adherence; however, baseline total depression symptoms and cognitive symptoms in particular as well as major and minor depression were significant predictors of adherence. These findings highlight the need for early identification and aggressive treatment of depression to optimize ART adherence.

Key Findings

  • Cognitive depressive symptoms in the first year of ART, such as depressed mood and loss of interest in activities, are predictive of adherence to the medication.
  • Moderate to severe depression seems to interfere with adherence more than mild depression, as expected.
  • An association between mild depression and lapses in medication adherence was also observed, suggesting that HIV-positive patients should receive routine depression screening and early intervention.
  • No relationship was found between change in depression status and change in ART adherence in the first year of treatment.

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