Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressive disorder, factors associated with non-viral suppression remain uncertain. We determined the prevalence and identified the factors associated with viral non-suppression among PLWH with major depressive disorder using ART in Northern Uganda. Method: A total of 30 primary care HIV clinics across three northern districts (Gulu, Kitgum, Pader) participated in the study. Using baseline data from the SEEK-GSP study, a cluster-randomized trial in northern Uganda (2016-2019) that involved 1140 PLWH with mild to moderate major depressive disorder; we examined the demographic, clinical, and psychosocial factors using standardized questionnaires. Data on viral load was abstracted from clinic records and dichotomized into suppressed (<1000 viral copies/mL) and non-suppressed (≥1000 viral copies/mL). We used generalized linear regression models to evaluate the factors associated with non-viral suppression. Results: We recruited 1140 PLWH. The viral non-suppression prevalence was 12.2%. In multivariable analysis, the only baseline psychosocial variable independently associated with non-viral suppression was suicide risk (PRR = 1.56, 95% CI: 1.05 - 2.32, p-value = 0.029). The prevalence odds for non-viral suppression were 56% higher among depressed PLWH with moderate to high suicide risk than those with low suicide risk. Among clinical variables, duration on ART ≥ 4 years was independently associated with non-viral suppression (PRR = 1.62, 95% CI: 1.09 - 2.32, p-value = 0.015). Conclusions: Suicide risk and longer duration on ART are associated with non-viral suppression among anti-retroviral therapy users with mild to moderate major depressive disorder in Uganda. As ART is scaled up across Sub-Saharan Africa, first-line psychological care for depression and its complications is urgently needed in established HIV treatment centers.
References
[1]
World Health Organization (2018) Antiretroviral Therapy Coverage in Sub-Saharan Africa. https://www.who.int/hiv/data/art_coverage/en/
[2]
World Health Organization, Department of HIV/AIDS (2015) Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. World Health Organization, Geneva. http://www.ncbi.nlm.nih.gov/books/NBK327115/
[3]
UAC (2018) Uganda HIV/AIDS Country Progress Report July 2016-June 2017. Commission UA, Kampala.
[4]
World Health Organization (2016) Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection (2016). http://www.who.int/hiv/pub/arv/arv-2016/en/
[5]
Loutfy, M.R., Wu, W., Letchumanan, M., Bondy, L., Antoniou, T., Margolese, S., et al. (2013) Systematic Review of HIV Transmission between Heterosexual Serodiscordant Couples Where the HIV-Positive Partner Is Fully Suppressed on Antiretroviral Therapy. PLoS ONE, 8, Article ID: e55747. https://doi.org/10.1371/journal.pone.0055747
[6]
UNAIDS (2014) Joint United Nations Programme on HIV/AIDS, Joint United Nations Programme on HIV/Aids. 90-90-90: An Ambitious Treatment Target to Help End the AIDS Epidemic. Geneva.
[7]
Passchier, R.V., Abas, M.A., Ebuenyi, I.D. and Pariante, C.M. (2018) Effectiveness of Depression Interventions for People Living with HIV in Sub-Saharan Africa: A Systematic Review & Meta-Analysis of Psychological & Immunological Outcomes. Brain, Behavior, and Immunity, 73, 261-273. https://doi.org/10.1016/j.bbi.2018.05.010
[8]
Sin, N.L. and DiMatteo, M.R. (2014) Depression Treatment Enhances Adherence to Antiretroviral Therapy: A Meta-Analysis. Annals of Behavioral Medicine, 47, 259-269. https://doi.org/10.1007/s12160-013-9559-6
[9]
Bernard, C., Dabis, F. and de Rekeneire, N. (2017) Prevalence and Factors Associated with Depression in People Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. PLoS ONE, 12, Article ID: e0181960. https://doi.org/10.1371/journal.pone.0181960
[10]
Nakimuli-Mpungu, E., Bass, J.K., Alexandre, P., Mills, E.J., Musisi, S., Ram, M., Katabira, E. and Nachega, J.B. (2012) Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review. AIDS and Behavior, 16, 2101-2118. https://doi.org/10.1007/s10461-011-0087-8
[11]
Sheehan, D., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., et al. (1998) The Mini International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33; quiz 34-57.
[12]
Beusenberg, M., Orley, J. and World Health Organization (1994) A User’s Guide to the Self-Reporting Questionnaire (SRQ). World Health Organization, Geneva.
[13]
Patterson, W.M., Dohn, H.H., Bird, J. and Patterson, G.A. (1983) Evaluation of Suicidal Patients: The SAD PERSONS Scale. Psychosomatics, 24, 343-345+348-349. https://doi.org/10.1016/S0033-3182(83)73213-5
[14]
Mollica, R., mcdonald, L., massagli, M. and silove, D. (2004) Measuring Trauma, Measuring Torture: Instructions and Guidance on the Utilization of the Harvard Program in Refugee Trauma’s Versions of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Harvard Program in Refugee Trauma, Cambridge, MA.
[15]
Saunders, J.B., Aasland, O.G., Babor, T.F., de la Fuente, J.R. and Grant, M. (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction, 88, 791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
[16]
Carver, C., Scheier, M. and Weintraub, J. (1989) Assessing Coping Strategies: A Theoretically Based Approach. Journal of Personality and Social Psychology, 56, 267-283. https://doi.org/10.1037/0022-3514.56.2.267
[17]
Kalichman, S.C., Simbayi, L.C., Jooste, S., Toefy, Y., Cain, D., Cherry, C., et al. (2005) Development of a Brief Scale to Measure AIDS-Relatedstigma in South Africa. AIDS and Behavior, 9, 135-143. https://doi.org/10.1007/s10461-005-3895-x
[18]
Bulage, L., Ssewanyana, I., Nankabirwa, V., Nsubuga, F., Kihembo, C., Pande, G., et al. (2017) Factors Associated with Virological Non-Suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015. BMC Infectious Diseases, 17, Article No. 326. https://doi.org/10.1186/s12879-017-2428-3
[19]
Mars, B., Burrows, S., Hjelmeland, H. and Gunnell, D. (2014) Suicidal Behaviour across the African Continent: A Review of the Literature. BMC Public Health, 14, Article No. 606. https://doi.org/10.1186/1471-2458-14-606
[20]
López, J.D., Shacham, E. and Brown, T. (2018) Suicidal Ideation Persists among Individuals Engaged in HIV Care in the Era of Antiretroviral Therapy. AIDS and Behavior, 22, 800-805. https://doi.org/10.1007/s10461-016-1666-5
[21]
Durham, M.D., Armon, C., Mahnken, J.D., Novak, R.M., Palella Jr., F.J., Tedaldi, E., Buchacz, K. and HOPS Investigators (2020) Rates of Suicidal Ideation among HIV-Infected Patients in Care in the HIV Outpatient Study 2000-2017, USA. Preventive Medicine, 134, Article ID: 106011. https://doi.org/10.1016/j.ypmed.2020.106011
[22]
Quinlivan, E.B., Gaynes, B.N., Lee, J.S., Heine, A.D., Shirey, K., Edwards, M., Modi, R., Willig, J. and Pence, B.W. (2017) Suicidal Ideation Is Associated with Limited Engagement in HIV Care. AIDS and Behavior, 21, 1699-708. https://doi.org/10.1007/s10461-016-1469-8
[23]
Diress, G., Dagne, S., Alemnew, B., Adane, S. and Addisu, A. (2020) Viral Load Suppression after Enhanced Adherence Counseling and Its Predictors among High Viral Load HIV Seropositive People in North Wollo Zone PUBLIC Hospitals, Northeast Ethiopia, 2019: Retrospective Cohort Study. AIDS Research and Treatment, 2020, Article ID: 8909232. https://doi.org/10.1155/2020/8909232
[24]
Bukenya, D., Mayanja, B.N., Nakamanya, S., Muhumuza, R. and Seeley, J. (2019) What Causes Non-Adherence among Some Individuals on Long Term Antiretroviral Therapy? Experiences of Individuals with Poor Viral Suppression in Uganda. AIDS Research and Therapy, 16, Article No. 2. https://doi.org/10.1186/s12981-018-0214-y
[25]
Joseph Davey, D., Abrahams, Z., Feinberg, M., Prins, M., Serrao, C., Medeossi, B., et al. (2018) Factors Associated with Recent Unsuppressed Viral Load in HIV-1-Infected Patients in Care on First-Line Antiretroviral Therapy in South Africa. International Journal of STD & AIDS, 29, 603-610. https://doi.org/10.1177/0956462417748859
[26]
Pujades-Rodríguez, M., O’Brien, D., Humblet, P. and Calmy, A. (2008) Second-Line Antiretroviral Therapy in Resource-Limited Settings: The Experience of Médecins Sans Frontières. AIDS, 22, 1305-1312. https://doi.org/10.1097/QAD.0b013e3282fa75b9
[27]
Mee, P., Fielding, K.L., Charalambous, S., Churchyard, G.J. and Grant, A.D. (2008) Evaluation of the WHO Criteria for Antiretroviral Treatment Failure among Adults in South Africa. AIDS, 22, 1971-1977. https://doi.org/10.1097/QAD.0b013e32830e4cd8
[28]
Kemp, C.G., Lipira, L.L., David, H.U., Nevin, P.E., Turan, J., Simoni, J.M., Cohn, S.E., Mieoak, B.A., Berzins, B., Andrasik, M. and Mugavero, M. (2019) HIV Stigma and Viral Load among African-American Women Receiving Treatment for HIV: A Longitudinal Analysis. AIDS, 33, 1511-1519. https://doi.org/10.1097/QAD.0000000000002212
[29]
Barai, N., Monroe, A., Lesko, C., Lau, B., Hutton, H., Yang, C., Alvanzo, A., McCaul, M.E. and Chander, G. (2017) The Association between Changes in Alcohol Use and Changes in Antiretroviral Therapy Adherence and Viral Suppression among Women Living with HIV. AIDS and Behavior, 21, 1836-1845. https://doi.org/10.1007/s10461-016-1580-x
[30]
Birner, R., Cohen, M.J., Ilukor, J., Muhumuza, T., Schindler, K. and Mulligan, S. (2011) Rebuilding Agricultural Livelihoods in Post-Conflict Situations: What Are the Governance Challenges? The Case of Northern Uganda. International Food Policy Research Institute, Washington DC.
[31]
Hosseinipour, M., Nelson, J.A., Trapence, C., Rutstein, S.E., Kasende, F., Kayoyo, V., Kaunda-Khangamwa, B., Compliment, K., Stanley, C., Cataldo, F. and van Lettow, M. (2017) Viral Suppression and HIV Drug Resistance at 6 Months among Women in Malawi’s Option B+ Program: Results from the PURE Malawi Study. Journal of Acquired Immune Deficiency Syndromes, 75, S149-S155. https://doi.org/10.1097/QAI.0000000000001368
[32]
Labhardt, N.D., Bader, J., Lejone, T.I., et al. (2016) Should Viral Load Thresholds Be Lowered?: Revisiting the WHO Definition for Virologic Failure in Patients on Antiretroviral Therapy in Resource-Limited Settings. Medicine, 95, Article No. e3985. https://doi.org/10.1097/MD.0000000000003985
