Influence of depression and interpersonal support on adherence to antiretroviral therapy among people living with HIV

Abstract

Background Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing and adhering to ART but are under-studied in low-income countries. The purpose of this study was to examine the association of interpersonal support and depression scores with adherence to ART among persons living with HIV (PLWH) in the Volta region of Ghana. Methods We conducted a cross-sectional survey among 181 PLWH 18 years or older who receive care at an ART clinic between November 2021 and March 2022. The questionnaire included a 6-item simplified ART adherence scale, the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), and the 12-item Interpersonal Support Evaluation List-12 (ISEL-12). We first used a chi-squared or Fisher’s exact test to assess the association between these and additional demographic variables with ART adherence status. We then built a stepwise multivariable logistic regression model to explain ART adherence. Results ART adherence was 34%. The threshold for depression was met by 23% of participants, but it was not significantly associated with adherence in multivariate analysis(p = 0.25). High social support was reported by 48.1%, and associated with adherence (p = 0.033, aOR = 3.45, 95% CI = 1.09–5.88). Other factors associated with adherence included in the multivariable model included not disclosing HIV status (p = 0.044, aOR = 2.17, 95% CI = 1.03–4.54) and not living in an urban area (p = 0.00037, aOR = 0.24, 95% CI = 0.11–0.52). Conclusion Interpersonal support, rural residence, and not disclosing HIV status were independent predictors of adherence to ART in the study area.

Impact of COVID-19 on people living with HIV and HIV care: A qualitative study in the Volta Region of Ghana

“…Participants were excluded if they were seriously ill (defined as hospitalization) or had a mental impairment. More information on our study methods can be found elsewhere [25].…”

Predictors of HIV status disclosure among PLHIV in the Volta region of Ghana: the disclosure conundrum and its policy implications.

“…Thus, a nal census of 181 participants was done for the study. Details of sample size and power calculations are published by the authors in Nutor et al (2023).…”

“…Studies on HIV status disclosure show disclosure outcomes can be complex and could result in isolation and diminished social support by partners if not well managed and supported (Kimberly et al, 1995). Indeed, a recent study in Ghana found that ART adherence rate was paradoxically higher among "status non-disclosed" group than "status disclosed" group (Nutor et al, 2023).…”

Psychometric and Circumplex Properties Evaluation of the International Personality Item Pool-Interpersonal Circumplex (IPIP-IPC) in Chinese People Living with HIV (PLWH)

“…9 Within the context of social function, a crucial element is social support. 10 Furthermore, social support is associated with many health outcomes, such as ART adherence, 11 viral load suppression, 12 and anxiety and depression. 13 However, due to widely held misconceptions and stereotypes surrounding HIV, PLWH may encounter social discrimination and stigmatization, leading to a loss of social support and feelings of isolation.…”