Depression During Pregnancy and the Postpartum Among HIV-Infected Women on Antiretroviral Therapy in Uganda

Kaida, Angela; Matthews, Lynn T.; Ashaba, Scholastic; Tsai, Alexander C.; Kanters, Steve; Robak, Magdalena; Psaros, Christina; Kabakyenga, Jerome; Boum, Yap; Haberer, Jessica; Martin, Jeffrey N.; Hunt, Peter W.; Bangsberg, David R.

doi:10.1097/qai.0000000000000370

Cited by 56 publications

(71 citation statements)

References 75 publications

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“…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).…”

Section: Discussioncontrasting

confidence: 47%

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

et al. 2017

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Background Depression is a known barrier for antiretroviral therapy (ART) adherence, but less is understood about its effects on ART initiation. Methods We followed 1,013 HIV-infected individuals participating in the Partners Demonstration Project, an open-label study of integrated pre-exposure prophylaxis (PrEP) and ART delivery for HIV serodiscordant couples in Kenya and Uganda. Associations between depression, measured annually with the Hopkins Symptoms Checklist-Depression (HSCL-D), and ART initiation were assessed with Cox proportional hazards regression. Results At enrollment, 162 participants (16.0%) reported symptoms consistent with probable depression, defined by a HSCL-D mean score >1.75, and this proportion decreased during study follow-up (6.7% and 3.6% at 12- and 24-months, respectively; p-value <0.001). Greater depressive symptom severity was associated with a greater likelihood of ART initiation overall (adjusted hazard ratio [aHR] 1.32, 95% CI:1.01–1.73) and among participants with CD4 count ≤350 cells/μl (aHR 1.30, 95% CI:1.01–1.67). Depression decreased six months after ART initiation (adjusted odds ratio [aOR] 0.34, 95% CI:0.23–0.51). Discussion Among East African HIV-infected persons in HIV serodiscordant couples, depression was not a barrier to ART initiation. ART initiation was associated with improved depressive symptoms in this setting.

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Section: Discussioncontrasting

confidence: 47%

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

et al. 2017

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“…The HSCL-25 depression scale has previously been adapted and validated among adults in HIV-affected Ugandan communities (Bolton et al, 2003; Kaida et al, 2014). Average scores were generated for depression (15 item) and anxiety (10 item) subscales; higher scores indicating greater severity.…”

Section: Methodsmentioning

confidence: 99%

“…Rates of depression and anxiety are high among women living with HIV/AIDS (Hatcher et al, 2012; Kaida et al, 2014). Depression among mothers with young children is associated with multiple negative child behavioral and emotional outcomes (Leis, Heron, Stuart, & Mendelson, 2014), cognitive deficits and developmental delays (Black et al, 2010), and malnutrition (Surkan, Kennedy, Hurley, & Black, 2011).…”

Section: Introductionmentioning

confidence: 99%

Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda

et al. 2016

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Women living with HIV are at increased risk for psychosocial distress, especially among social and economically disadvantaged women living in rural areas. Little is known about how social support and wealth impacts the mental health of women caring for young children in low- and middle-income countries. The purpose of this paper was to assess demographic, socio-economic, and social support correlates of depression and anxiety in HIV-infected+ female caregivers living in rural Uganda. Depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25), two-domains of social support (family and community) were measured with the adapted Multidimensional Scale for Perceived Social Support, and wealth was measured using a checklist of material possessions and housing quality among 288 women. Multivariable linear regression models assessed the association of depression and anxiety with demographic and social predictors. Sixty one percent of women reported clinically significant symptoms of depression or anxiety using the standard HSCL-25 cut-off of >1.75. Lower wealth (p=0.01) and family support (p=0.01) were significantly associated with more depressive symptoms, with greater family support being more protective of depression in the highest wealth group (top 20%) compared to the lowest. More anxiety symptoms were associated with lower wealth (p=0.001), lower family support (p=0.02), and higher community support (p=0.003). Economic and social support factors are important predictors of caregiver mental health in the face of HIV disease in rural Uganda. Findings suggest that interventions should consider ways to increase economic opportunities and strengthen family support for HIV+ caregivers.

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“…In this cohort, 39% of women were depressed, with higher depression scores among pregnant and postpartum women [39] . While the rollout of Option B+ and other strategies to reduce perinatal transmission are important in supporting women to meet their reproductive goals and have uninfected children [40], supporting women’s mental and emotional health is also crucial to growing healthy families, communities, and populations.…”

Section: Introductionmentioning

confidence: 99%

Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda

Ashaba

Kaida

Burns

et al. 2017

BMC Pregnancy Childbirth

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BackgroundIn sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women.MethodsWe conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis.ResultsTwenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm3 (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality.ConclusionsThe results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1321-9) contains supplementary material, which is available to authorized users.

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Depression During Pregnancy and the Postpartum Among HIV-Infected Women on Antiretroviral Therapy in Uganda

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 56 publications

References 75 publications

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

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

Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda

Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda

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