Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

Abstract

Abstract. We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.

Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia

“…26 This instrument has been used successfully with other populations in Zambia and was not modified for this study. 27,28 Individuals who score greater than five on the SSQ are considered to warrant further psychological assessment. 29 Additional survey questions included: maternal and child demographics; maternal economic status; child developmental and nutritional status; and child seizure characteristics.…”

Cognitive Impairment and Psychiatric Morbidity in HIV+ Zambians with New-Onset Seizure

“…Compared with a large cohort of approximately 500 rural Zambians commencing cART as part of the Rural ART Adherence in Zambia (RAAZ) study, 8 where the mean IHDS was 9.0 (42.1% of participants scored below the norm) and the mean zMMSE was 21.6 (34.4% of participants scored below the norm), the means in the RAAZ and CHASE populations were fairly comparable, but more people in the CHASE cohort were below the norm, suggesting that they are, indeed, more impacted by cognitive impairment. All of the CHASE patients had seizures, and therefore, it is reasonable to consider that CHASE patients had a relatively higher level of CNS involvement (prior HIV, OI, etc.)…”

“…The zMMSE is commonly used by clinicians and researchers in Zambia. 4,7,8 The IHDS is a widely used scale for assessing HIV-associated dementia. The scale measures three neuropsychological domains, which include (1) memory and registration, (2) psychomotor speed, and (3) memory recall.…”

“…The IHDS has been used in Zambia to assess HAND with previously established norms using a cutoff of 10. 4,7,8 The SSQ is a 14-item instrument initially developed in neighboring Zimbabwe to identify symptoms of anxiety and depression. 17,18 Questions capture the presence or absence of specific anxiety and depressive symptoms, with a higher score indicating greater burden (maximum of 14).…”

“…7 Psychiatric morbidity (anxiety and depression symptoms), present in approximately 80% of individuals, was an independent predictor of early mortality, even after controlling for HIV stage. 8 Even if cART reduces HAND by approximately 60%, over 8 million HIV-infected adults in sub-Saharan Africa will be cognitively impaired at some level. 9 Some have hypothesized that people with HIV experience early aging.…”