Declining Prevalence of Probable Depression Among Patients Presenting for Antiretroviral Therapy in Rural Uganda: The Role of Early Treatment Initiation

Abstract

Little is known about trends in depression at antiretroviral therapy (ART) initiation among people living with HIV (PLHIV) in low- and middle-income countries. We used data from an ongoing cohort of treatment-naïve PLHIV in rural Uganda to estimate secular trends in depression among PLHIV at ART initiation. We fitted linear regression models with depression symptom severity as the outcome variable and year of cohort entry (2005–2012) as the explanatory variable, adjusting for socio-demographic variables and assessing physical health score, body mass index (BMI), and CD4 count as potential mediators of a secular trend in depression symptom severity. There was a statistically significant negative association between year of entry and depression symptom severity, suggesting a 3.1% relative decline in the mean depression symptom severity score at ART initiation in each year of study recruitment after the first year. This trend remained statistically significant after inclusion of baseline socio-demographic characteristics to the model and appeared to be driven by improved physical health scores, but not CD4 count or BMI.

Depression and ART Initiation Among HIV Serodiscordant Couples in Kenya and Uganda

“…In addition, while other studies in sub-Saharan Africa have also found reductions in depressive symptoms at 12-months after ART initiation, our findings demonstrate a more rapid change in depressive symptoms as well as a decline in HIV-related stigma and an increase in social support during study follow-up (39,41,42). ART use may mitigate depressive symptoms by acting through psychological, behavioral, or biological pathways (39,41–45).…”

“…In addition, while other studies in sub-Saharan Africa have also found reductions in depressive symptoms at 12-months after ART initiation, our findings demonstrate a more rapid change in depressive symptoms as well as a decline in HIV-related stigma and an increase in social support during study follow-up (39,41,42). ART use may mitigate depressive symptoms by acting through psychological, behavioral, or biological pathways (39,41–45). For example, regular ART use can result in lower HIV RNA viral loads and higher CD4 counts, improved physical health and quality of life, and reduced general distress, which may in turn lead to less severe depression (39,43,45).…”

“…ART use may mitigate depressive symptoms by acting through psychological, behavioral, or biological pathways (39,41–45). For example, regular ART use can result in lower HIV RNA viral loads and higher CD4 counts, improved physical health and quality of life, and reduced general distress, which may in turn lead to less severe depression (39,43,45). Prior research on the association between ART use and depression has largely been conducted in cohorts with more advanced HIV disease than this cohort.…”

“…Finally, since depressive symptoms have been shown to decrease one year after ART initiation, we examined odds of probable depression at enrollment versus the study visit six and 12 months after ART initiation within participants using conditional logistic regression and the same adjustment factors as specified in the proportional hazards model (38,39). All analyses were conducted using SAS 9.4 (Cary, North Carolina, USA).…”

Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

“…Based on the HSCL (cut-off>1.75 with 11–15 items) ( Table 2D ), the pooled prevalence of depressive symptoms among untreated or mixed groups of PLHIV was 24% [95% CI: 22–27] with a high between-group heterogeneity (I 2 = 85%) ( Fig 3D -right) [ 63 – 65 ]. Some studies specified that they used the scale without somatic symptoms [ 63 , 65 ].…”