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. 2017 Aug;21(8):2509-2518.
doi: 10.1007/s10461-017-1829-z.

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

Jennifer Velloza  1   2 , Connie Celum  1   2   3 , Jessica E Haberer  4 , Kenneth Ngure  5   6 , Elizabeth Irungu  6 , Nelly Mugo  7 , Jared M Baeten  1   2   3 , Renee Heffron  8   9   10 ; Partners Demonstration Project Team
Collaborators, Affiliations

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

Jennifer Velloza et al. AIDS Behav. 2017 Aug.

Abstract

Depression is a known barrier for antiretroviral therapy (ART) adherence, but less is understood about its effects on ART initiation. We followed 1013 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. 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 6 months after ART initiation (adjusted odds ratio [aOR] 0.34, 95% CI 0.23-0.51). 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.

Keywords: Africa; Antiretroviral therapy initiation; Depression; HIV.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

Figure I
Figure I
The cumulative probability of ART initiation by probable depression and CD4 cell count at enrollment (n=973)
See this image and copyright information in PMC

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