Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review (original) (raw)
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Alcohol Use, Depressive Symptoms and the Receipt of Antiretroviral Therapy in Southwest Uganda
AIDS and Behavior, 2008
Alcohol use and depressive symptoms are associated with reduced access to antiretroviral therapy (ART) in the developed world. Whether alcohol use and depressive symptoms limit access to ART in resource-limited settings is unknown. This cross-sectional study examined the association between alcohol use, depressive symptoms and the receipt of ART among randomly selected HIVpositive persons presenting for primary health care services at an outpatient HIV clinic in Uganda. Depressive symptoms were defined by the Hopkins Symptom Checklist and alcohol use was measured through frequency of consumption questions. Antiretroviral use was assessed using a standardized survey and confirmed by medical record review. Predictors of ART use were determined via logistic regression. Among 421 HIV-infected patients, factors associated with the receipt of ART were having at least primary education, having an opportunistic infection in the last 3 months, and not drinking within the last year.
African Journal of Psychiatry, 2010
Objective: To determine the prevalence of depressive disorder in patients with HIV/AIDS receiving HAART; to determine the effect of depressive disorder on adherence to antiretroviral therapy; and to determine the significance of the association. Method: The study was conducted amongst outpatients of Ahmadu Bello University Teaching Hospital, Zaria. A sociodemographic and drug adherence questionnaire was administered. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to screen for depressive symptoms while the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of depressive disorder. Results: A total of 310 patients with HIV/AIDS receiving HAART participated in the study. 68.4% were female and the mean age was 35.5 (± 8.97 years). 37.4% had secondary education, while 27.1% had tertiary education. Sixty-six participants (21.3%) had significant depressive symptoms while 14.2% met ICD-10 diagnostic criteria for depressive disorder. Overall, 73% of participants had good adherence to HAART. 63.6% of participants with depressive disorder had poor adherence to HAART compared to 21.1% of participants without depressive disorder (p<0.05). Conclusion: Depressive disorder in patients with HIV/AIDS is associated with poor adherence to antiretroviral medication. Early identification and treatment of depression in such patients may improve antiretroviral medication adherence and treatment outcomes.
Journal of Affective Disorders, 2013
Background: There is limited information on the impact of lifetime depressive disorders on adherence to ART. Aim: We examined the association between lifetime depressive disorders and adherence to antiretroviral therapy (ART) among a rural clinic-based HIV positive population. We further explored whether this association was mediated by current depression and moderated by gender. Methods: Two hundred HIV positive individuals who had o 95% adherence and two hundred HIV positive individuals who had Z95% adherence were screened for depression using the self-reporting questionnaire (SRQ-20) and evaluated with the Mini neuropsychiatric interview (MINI). Multivariate logistic regression was used to assess the association between lifetime depressive disorders and adherence to ART. The logistic regression model of Baron and Kenny was used to evaluate the mediating effect of current depression. Hierarchical binomial logistic regression was used to evaluate the moderating effect of gender. Results: HIV positive individuals with lifetime depressive disorders had an increased risk of nonadherence to ART after controlling for education status, income, self-efficacy, perceived social support, cognitive impairment and current alcohol use disorders [AOR¼ 1.68, 95%CI (1.02-2.79), p¼ 0.04]. This association was stronger in females than males [AOR ¼ 4.76,), p¼ 0.008]. Limitations: Findings cannot be generalized to ART naïve individuals or those using ART for less than six months. Conclusion: Lifetime depressive disorders are associated with increased risk of non-adherence to ART in rural women with HIV infection in southern Uganda. Detection and treatment of depression can potentially improve adherence with HIV treatment in this setting.
AIDS Care, 2020
Although there is evidence of individual associations between depressive symptoms and hazardous alcohol use with suboptimal antiretroviral therapy (ART) adherence among people living with HIV (PLWH), few studies have established how the two risk factors may interact to predict viral suppression. We conducted secondary data analyses with two cohorts of Ugandan PLWH (N = 657) to investigate the hypothesized interaction between depressive symptoms (Center for Epidemiological Studies Depression Scale) and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption and/or Phosphatidylethanol biomarker) prior to ART initiation with viral suppression (<550 copies/ml). We were unable to detect an interaction between depressive symptoms and hazardous alcohol use prior to ART initiation with viral suppression in the first two years (M = 19.9 months) after ART initiation (p = 0.75). There was also no evidence of a main effect association for depressive symptoms (Adjusted Odds Ratio [AOR] = 0.88, 95% Confidence Interval [CI]: 0.50, 1.55) or hazardous alcohol use (AOR = 1.37, 95% CI: 0.80, 2.33). PLWH with depressive symptoms and/or hazardous alcohol use appear to exhibit similar levels of viral suppression as others in care; further work is needed to determine effects on HIV testing and treatment engagement.
2020
Background: Kenya is faced with an increasing challenge of co-morbid psychological and social factors among HIVInfected patients which has had a profound impact on their medication adherence. A major psychosocial factor that is a barrier in adherence is depression associated with HIV. This study aimed at measuring the effect of depression on participants' own reported adherence to antiretroviral therapy. Objectives: To determine the impact depression has had on adherence to antiretroviral therapy among HIV-infected patients at a Kenyatta Hospital. Methodology: A cross-sectional study design was carried out at Kenyatta National Hospital, Nairobi, Kenya. Three hundred and eighty four (384) HIV infected participants were assessed for HIV related depression and adherence to ART. Levels of HIV related depression and adherence to ART were ascertained. Results: The prevalence of depression was 23.3 %. The prevalence of mild, moderate and severe depression was 21.2 %, 1.8 % and 0.3 % r...
Sao Paulo Medical Journal, 2014
CONTEXT AND OBJECTIVE:Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms.DESIGN AND SETTING:This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007.METHODS:438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ).RESULTS:The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell co...
AIDS and Behavior
Although alcohol use is associated with depression, it is unclear if brief alcohol reduction interventions can ameliorate depression and psychological distress among people with HIV (PWH). We use data from a two-arm randomised controlled trial to examine this question. PWH on antiretroviral treatment (ART) were randomly assigned to receive a brief intervention or treatment as usual (n = 622). Screening was done with the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, Centre for Epidemiological Studies Depression inventory and Kessler Psychological Distress Scale, at baseline and at 3- and 6-months post-baseline. Changes in depression and psychological distress was assessed using analysis of covariance models with baseline measures of alcohol consumption, sex and age included as covariates and adjusting for baseline symptom severity. Changes in alcohol consumption between baseline and follow-up were included in the analysis to establish if this affected outcomes. For both...
Journal of the …, 2010
John Farley, MD, MPH1, Erin Miller, MS, RN1, Andrew Zamani, PhD2, Vicki Tepper, PhD3, Chester Morris, MD, MSc4, Modupe Oyegunle, MPH1, Maria Lin Eng, DrPH, MPH1, Manhattan Charurat, PhD1, and William Blattner, MD1 ... Abstract Scores from the Alcohol Use ...
Kathmandu University medical journal, 2019
Background Depression and alcohol use disorder are very common among people living with HIV infection, these disorders are not only common among HIV patients but also associated with antiretroviral therapy (ART) non adherence, morbidity and mortality. Objective The objective of our study is to study the prevalence of Depression, Alcohol use, and ART treatment adherence. Method This is a analytical cross-sectional study. Total of 221 participants were included in the study. Convenient method of sampling was used to collect the data from three district Kathmandu, Lalitpur and Kavre ART (Antiretroviral treatment) clinics. Beck Depression Inventory (BDI) was used for the assessment of depression, Alcohol use disorders identification test (AUDIT) was used for alcohol related problems and Visual analogue scale (VAS) was used for treatment adherence. Chi square test and multiple linear regression analysis were conducted for testing bivariate and multivariate relationship of sociodemographi...
Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West Africa
Addiction, 2010
Aim To investigate the association between alcohol use and adherence to highly active antiretroviral treatment (HAART) among human immunodeficiency virus (HIV)-infected patients in subSaharan Africa. Design and setting Cross-sectional survey conducted in eight adult HIV treatment centres from Benin, Côte d'Ivoire and Mali. Participants and measurements During a 4-week period, health workers administered the Alcohol Use Disorders Identification Test to HAART-treated patients and assessed treatment adherence using the AIDS Clinical Trials Group follow-up questionnaire. Findings A total of 2920 patients were enrolled with a median age of 38 years [interquartile range (IQR) 32-45 years] and a median duration on HAART of 3 years (IQR 1-4 years). Overall, 91.8% of patients were identified as adherent to HAART. Non-adherence was associated with current drinking [odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1-2.0], hazardous drinking (OR 4.7; 95% CI 2.6-8.6) and was associated inversely with a history of counselling on adherence (OR 0.7; 95% CI 0.5-0.9). Conclusions Alcohol consumption and hazardous drinking is associated with non-adherence to HAART among HIV-infected patients from West Africa. Adult HIV care programmes should integrate programmes to reduce hazardous and harmful drinking.