Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States

Abstract

Objective:Depression is prevalent among persons with HIV (PWH) and is associated with poorer adherence and lack of viral load suppression (VLS). When treated for depression, PWH are more likely to stay in HIV care and adhere to medications; however, for many PWH, depression is not adequately diagnosed or treated. We adapted Progression and Transmission of HIV (PATH 3.0), a U.S. agent-based dynamic stochastic simulation model, by incorporating a continuum of depression care and estimating the impact on VLS of an enhanced depression diagnosis and care scenario (EDC).Methods:We compared EDC – whereby every PWH is assessed for depression, gets treatment if diagnosed, and of those, half achieve remission – to a status quo scenario (SQ) on VLS. Based on published findings, assumptions for SQ were: 34.7% depressed, 45% diagnosed, 55.3% treated and 33% of treated achieving remission. Compared to PWH without depression, we assumed the probability of being non-virally suppressed increased by 1.57 times for PWH with depression (PWH-D), and by 0.95 times for PWH with remitted depression.Results:There was an average increase of 14.6% (11.5–18.5) in the proportion of PWH-D who achieved VLS in EDC compared to SQ. Among all PWH, there was a 4.7% (3.4–6.0) increase in the proportion who achieved VLS in EDC compared to SQ.Conclusions:Fully diagnosing and adequately treating depression would improve health and quality of life for a substantial proportion of PWH-D and result in a nearly 5% increase in expected rates of VLS in the United States, supporting national prevention goals.

Time to get it right: investing in the mental wellbeing of people living with HIV

“…We know that this investment will have a dramatic impact on the mental health and quality of life of people living with HIV. And thanks to Dr Koenig and colleagues [12], we have firm evidence that such an investment will also have a profound and measurable impact on the national HIV epidemic. It's time to act.…”

“…We know that combined treatment approaches that integrate mental health counseling with skill-building around medication adherence and HIV care are particularly impactful [9][10][11]. And now, thanks to the compelling, intricate, and elegant analysis by Koenig and colleagues in this issue, we know that comprehensively addressing depression among people with HIV in the United States would lead to a substantial and impactful improvement in national levels of HIV viral suppression, with consequent gains in health, longevity, and prevention of transmission [12].…”