International AIDS Society

Depression Lowers Chances of ART Adherence 55%: 23 African Studies

Author: Mark Mascolini

17 November 2012

Symptoms of depression affected almost one third of HIV-positive people involved in 23 sub-Saharan African studies, according to results of a meta-analysis. People with depression were 55% less likely to achieve good adherence to antiretroviral therapy (ART) than people without depression.

Depression affects people with HIV across the world. It can impair adherence to treatment and have other negative health consequences. To get an overview of the rate and impact of depression in sub-Saharan Africa, researchers scoured electronic databases for studies that documented rates of mental health problems and that were published between January 2006 and July 2011.

The investigators pooled results of 23 studies that reported rates of depression symptoms (assessed with screening instruments) and 6 studies that reported rates of major depression (diagnosed by diagnostic interviews). These analyses calculated an overall depression symptom rate of 31.2% (95% confidence interval [CI] 25.5% to 38.2%) and an overall major depression rate of 18% (95% CI 12.3% to 25.8).

Overall rates of depression symptoms did not differ substantially between antiretroviral-experienced people (31.8%, 95% CI 22% to 44%) and antiretroviral-naive people (29.8%, 95% CI 17% to 47%).

Compared with people without depression, those with depression symptoms had a 55% lower chance of achieving good antiretroviral adherence (pooled odds ratio 0.45, 95% CI 0.31 to 0.66, P = 0.000).

The researchers note that pooled rates of depression symptoms and major depression in this analysis “are much higher than prevalence estimates of depression symptoms and major depression in community studies in Uganda and South Africa, which suggests that depressive symptoms and major depression in HIV-positive individuals represent a significant public health concern.”

The authors “recommend that screening for depression and alcohol use/abuse should be integrated with voluntary counselling and testing (VCT) for HIV infection and with post-test or ongoing counselling sessions for HIV-positive individuals.”

Source: Etheldreda Nakimuli-Mpungu, Judith K. Bass, Pierre Alexandre, Edward J. Mills, Seggane Musisi, Malathi Ram, Elly Katabira, Jean B. Nachega. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS and Behavior. 2012; 16: 2101-2118.

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