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. 2023 Jun;27(6):1849-1861.
doi: 10.1007/s10461-022-03916-x. Epub 2023 Jan 2.

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

Andreas D Haas  1 , Raphael Lienhard  2 , Christiane Didden  2   3 , Morna Cornell  4 , Naomi Folb  5 , Tebatso M G Boshomane  6   7 , Luisa Salazar-Vizcaya  8 , Yann Ruffieux  2 , Patience Nyakato  4 , Anja E Wettstein  2   9 , Mpho Tlali  4 , Mary-Ann Davies  4 , Per von Groote  2 , Milton Wainberg  10 , Matthias Egger  2   4   11 , Gary Maartens  12 , John A Joska  13   14
Affiliations

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

Andreas D Haas et al. AIDS Behav. 2023 Jun.

Abstract
in English, Spanish

We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22-1.96], substance use disorders (aRR 1.53, 95% CI 1.19-1.97), serious mental disorders (aRR 1.30, 95% CI 1.09-1.54), and depression (aRR 1.19, 95% CI 1.10-1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15-19 years), and young adults (20-24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes-particularly of adolescents and young adults-and supports strengthening mental health services in HIV treatment programmes.

Monitoreamos adolescentes y adultos mayores de 15 años que viven con VIH y que están registrados en un programa privado Surafricano para el tratamiento del VIH. Nuestro propósito fue examinar adherencia a los medicamentos y supresión viral (carga viral < 400 copias/mL) en los participantes con (20,743, 38%) y sin (33,635, 62%) diagnósticos de salud mental. Los diagnósticos de salud mental estuvieron asociados con patrones de adherencia desfavorables. Comparados con pacientes sin diagnósticos de salud mental, el riesgo de no supresión viral fue más alto entre pacientes con desórdenes mentales orgánicos [riesgo relativo ajustado (aRR) 1.55, 95% intervalo de confidencia (CI) 1.22–1.96], desórdenes en el uso de sustancias (aRR 1.53, 95% CI 1.19–1.97), desórdenes mentales serios (aRR 1.30, 95% CI 1.09–1.54), y depresión (aRR 1.19, 95% CI 1.10–1.28). El riesgo de no supresión viral también fue más alto en hombres que en mujeres, en adolescentes (15–19 años), y en adultos jóvenes. Nuestro estudio resalta la necesidad de intervenciones psicosociales para mejorar los resultados del tratamiento contra el VIH –particularmente en adolescentes y adultos jóvenes—, y respalda el fortalecimiento de servicios de salud mental como parte de los programas para el tratamiento del VIH.

Keywords: Adherence; Antiretroviral therapy; HIV; Mental disorders; South Africa; Viral suppression.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative medication availability (CMA) in the 2nd year after baseline comparing participants with and without mental health diagnoses by age group and sex. Error bars represent 95% confidence intervals for means and proportions. N = 48,645
Fig. 2
Fig. 2
Adherence trajectories and the probability of being in each adherence group by sex, age and mental health diagnosis at baseline. A Shows the mean cumulative medication adherence (CMA) for the four groups identified in the longitudinal adherence trajectory analysis. B, C Shows the probability of being in each group by sex, age, and mental health diagnosis at baseline. Darker colours represent persons who did not received mental health diagnoses (ICD10 F00–F99) before or at baseline and lighter colours for those who received mental health diagnoses. We included participants with at least 3 years of follow-up in the analysis (N = 32,254)
Fig. 3
Fig. 3
Viral suppression (viral load < 400 copies/mL) at 2 years after baseline comparing participants with and without mental health diagnoses by age and sex. Error bars represent 95% confidence intervals for means and proportions. N = 28,785
See this image and copyright information in PMC

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDSInfo online database. [Internet]. [cited 2022 Apr 10]. Available from: https://aidsinfo.unaids.org/.
    1. Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418. doi: 10.1371/journal.pmed.1001418. - DOI - PMC - PubMed
    1. Haas AD, Zaniewski E, Anderegg N, Ford N, Fox MP, Vinikoor M, et al. Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes. J Int AIDS Soc. 2018;21(2):e25084. doi: 10.1002/jia2.25084. - DOI - PMC - PubMed
    1. Ford N, Darder M, Spelman T, Maclean E, Mills E, Boulle A. Early adherence to antiretroviral medication as a predictor of long-term HIV virological suppression: five-year follow up of an observational cohort. Ndhlovu LC, editor. PLoS ONE. 2010;5(5):e10460. doi: 10.1371/journal.pone.0010460. - DOI - PMC - PubMed
    1. Byrd KK, Hou JG, Hazen R, Kirkham H, Suzuki S, Clay PG, et al. Antiretroviral adherence level necessary for HIV viral suppression using real-world data. JAIDS. 2019;82(3):245–251. - PMC - PubMed

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