Impact of significant depression symptoms on adherence to tenofovir-based antiretroviral therapy in young women living with HIV in Kampala

Abstract

Background: After almost forty years of the HIV pandemic, Africa is still accounting for more than two-thirds of global infections. HIV infections are more prevalent in women (54%) compared to men, making them an important study population for the effects of depression on disease progression. To achieve the 95-95-95 targets set by UNAIDS, all possible efforts, including ensuring the optimum adherence to ART must be incorporated into the HIV healthcare system. One of the major deterrents to achieving this target is the potential association between sub-optimal adherence to ART and the presence of significant depression symptoms (SDS) among women living with HIV. Objective: To determine the longitudinal patterns of significant depression symptoms and their association with adherence to antiretroviral therapy over 24 months among 18 to 35-year-old women living with HIV on TDF-based regimens in Kampala, Uganda. Methods: This retrospective cohort study recruited 390 women living with HIV aged 18 to 35 years. Secondary quantitative data were collected from a cohort that was used for the BONECARE study. The treatment naïve women had been recruited from 11 selected health facilities in Kampala district which included both HIV care centres and general health facilities.. Depression symptoms were scored using the Hopkins Symptom Checklist 15 (HSCL-15), while adherence to ART was assessed using a 7-day self-report questionnaire on ART adherence. Results: The prevalence of SDS at baseline was approximately 18% (17.7%) (CI: 14.0%, 21.8%). The prevalence of SDS appeared to steadily drop from baseline reaching its lowest value at month 24. SDS did not affect the way adherence changed over time (p-value =0.61, CI; 0.95, 1.10), adherence to ART significantly changed over time regardless of SDS status (p-value= 0.004, CI; 1.01, 1.08) and finally, the presence of SDS does not influence adherence at baseline (p-value=0.126, CI; 0.16, 1.26). Age categorized and alcohol use influenced adherence at baseline. They had no confounding effect on the association between SDS and adherence but were independent predictors. Conclusion: The baseline prevalence of SDS was approximately 18% and it steadily decreased over the study period. The presence of SDS had no effect on adherence to ART both at baseline and how it changed over time. Finally, adherence to ART significantly changed over time regardless of the presence or absence of SDS. In addition to management of depression, PLWH should be closely monitored for their adherence to ART.