Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi
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ORIGINAL PAPER
Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi Melissa A. Stockton1 · Bradley N. Gaynes2 · Mina C. Hosseinipour3,6 · Audrey E. Pettifor1 · Joanna Maselko1 · Steven M. Mphonda3 · Kazione Kulisewa5 · Michael Udedi4,5 · Brian W. Pence1 Accepted: 14 September 2020 © The Author(s) 2020
Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression— is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement. Keywords Depression · HIV · Retention · Viral suppression · Sub-saharan africa
Introduction
* Melissa A. Stockton [email protected] 1
Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
2
Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC 27516, USA
3
University of North Carolina Project-Malawi, Tidziwe Centre, Private Bag A‑104, Lilongwe, Malawi
4
NCDs & Mental Health Unit, Ministry of Health, P. O. Box 30377, Capital City, Lilongwe 3, Malawi
5
College of Medicine, Department of Mental Health, University of Malawi, P/Bag 360, Chichiri, Blantyre 3, Malawi
6
Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC 27516, USA
The prevalence of HIV in sub-Saharan countries such as Malawi are among the highest in the world [1, 2]. Like many other countries in the region, Malawi, has adopted a “public health approach” to HIV scale-up in order to meet the UNAIDS 90-90-90 goals (diagnosing 90% of all people living with HIV, providing antiretroviral therapy [ART] to 90% of those diagnosed, and achieving viral suppression for 90% of those treated) [3–5]. Great strides have been made towards achieving these goals and engaging people living with HIV in care across the region [6
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