Probable antenatal depression at antiretroviral initiation and postpartum viral suppression and engagement in care

Abstract

Objective To estimate the association of probable antenatal depression with postpartum HIV care engagement among pregnant women in Malawi. Design We conducted a prospective cohort study of 299 women who were initiating antiretroviral therapy (ART) through Option B+ at a government antenatal clinic in Malawi. Methods Probable antenatal depression was assessed on the day of ART initiation with the validated Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS). We estimated crude and adjusted risk differences (RD, aRD) of visit attendance and prevalence differences (PD, aPD) of viral suppression through 12 months post-ART initiation comparing women with versus without probable antenatal depression. Results One in ten women had probable antenatal depression. Most women were engaged in care through 12 months post-ART initiation: 85% attended all scheduled ART visits, and 81% were in care and virally suppressed. Women with and without probable antenatal depression had a comparable probability of attending all scheduled visits (RD: −0.02; 95%CI −0.16–0.12; aRD: −0.04; 95%CI −0.18–0.10), and of viral suppression (PD: −0.02; 95%CI −0.17–0.13; aPD: −0.01; 95%CI −0.17–0.15) in crude and adjusted analyses. Conclusion Probable antenatal depression was not associated with engagement in HIV care through 12 months post-ART initiation. In a population with high HIV care engagement, antenatal depression may not impair HIV-related outcomes.

Early post-partum viremia predicts long-term non-suppression of viral load in HIV-positive women on ART in Malawi: Implications for the elimination of infant transmission

“…While pregnancy remains an important entry point for the current global 'Treat All' strategy, there is limited information regarding longitudinal VLS in this population [3]. Research studies reporting VLS estimates at various time points in the post-partum period signal particular challenges in reaching the UNAIDS goal of 90% VLS [4][5][6][7]. Further, among the few available population level estimates, we see a similar signal with Zimbabwe reporting VLS (<1000 copies/mL) in post-partum women on ART as 81.2% (CI: 79.4−83.1) at 4-12 weeks and 85.2% (CI: 82.9−87.4) at 12 months [8] and Uganda reporting a 3 year VLS (<1000 copies/mL) among post-partum women of 76% [9].…”

"Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi

“…It is possible that the women choosing to participate in our interviews were more likely to be those well engaged in care; it is also possible the women felt some social desirability pressure to report good adherence for themselves, while feeling more free to note that others might have such a difficulty. One explanation, as noted by another study in Lilongwe, Malawi is that because these women are in a population with high engagement in care, PND is not associated with lower ART adherence [39]. Another explanation our study found is that during this perinatal period, women may be more motivated to adhere to ART as they want to have a healthy pregnancy and remain healthy for raising their children.…”

“Pain in my heart”: Understanding perinatal depression among women living with HIV in Malawi

“…It is possible that the women choosing to participate in our interviews were more likely to be those well engaged in care; it is also possible the women felt some social desirability pressure to report good adherence for themselves, while feeling more free to note that others might have such a difficulty. One explanation, as noted by another study in Lilongwe, Malawi is that because these women are in a population with high engagement in care, PND is not associated with lower ART adherence (35). Another explanation our study found is that during this perinatal period, women may be more motivated to adhere to ART as they want to have a healthy pregnancy and remain healthy for raising their children.…”