Common mental health problems and antiretroviral therapy adherence

Abstract

This paper reviews the literature on various mental health problems and their impact on adherence to antiretroviral therapy (ART). Depression, anxiety disorders, and disorders related to substance abuse were identified as key role-players influencing adherence. The severity of symptoms related to these disorders was found to be inversely related to ART adherence, with the possible exception of post-traumatic stress disorder (PTSD). PTSD was found to have both positive and negative implications for adherence, with severity of symptoms ranging from health-protective concern to disabling distress. Possible solutions aimed at addressing the adverse effects of mental health problems on adherence are discussed. Routine screening in ART settings is suggested in settings where follow-up of positive screen scores are possible, along with the necessary interventions to resolve the disorder of concern. Suggested interventions include utilising psychotherapeutic treatment, both in isolation and in conjunction with medication, to address mental health problems. Furthermore, finding effective ways of marshalling social support is recommended for ensuring optimal adherence, and possibly mitigating the adverse effects of mental health problems. Further research is needed to find feasible ways of identifying, assessing and treating patients with mental health problems in resource-constrained settings where HIV prevalence is highest.

Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines

“…102 Patients with depressive symptoms or severe anxiety may lack the motivation and self-efficacy required to attend clinic appointments or to be adherent to antiretroviral therapy. 103 Untreated depression has been linked with poor health outcomes, including reduced immunologic response and death; 104 efforts should therefore be made to screen patients for mental illness and institute appropriate treatment. Guidelines recommend treatment in conjunction with adherence counselling to improve depressive symptoms, adherence to antiretroviral therapy, and health outcomes.…”

Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies

“…21 Given the above, it is critical from a public and individual perspective to investigate and describe the interventions that are effective in improving adherence to ART. Systematic reviews report that there is limited evidence on interventions to improve adherence to ART in the pediatric population; 22 yet older adults are less likely to be non-adherent; 23 there may be benefit in addressing mental health issues that affect adherence; 5,24,25 motivational interviewing may offer some benefit, 26 and reduce viral load in youth. 27 Weekly reminder text messages [28][29][30] and treatment supporters 29 also improve adherence and reduce viral load in low resource settings.…”

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA

“…Sin embargo, la adherencia se ve afectada por múltiples factores, en particular por los efectos secundarios del tratamiento 17,18,19,20 . Problemas de salud mental como la depresión 21 , así como el consumo de alcohol 22,23 y el abuso de sustancias, se asocian también a una baja adherencia al tratamiento 20,24,25,26,27,28,29 . Además, se ha encontrado asociación con efectos adversos específicos de los antirretrovirales 30,31 , entre otras causas 32,33 .…”