Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: A systematic review

Etheldreda Nakimuli-Mpungu, Judith K. Bass, Pierre Alexandre, Edward J. Mills, Seggane Musisi, Malathi Ram, Elly Katabira, Jean B. Nachega

Research output: Contribution to journalReview article

Abstract

This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association withART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5-38.2%, Tau2 = 0.23) and 18% (95% CI 12.3-25.8%, Tau2 = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31-0.66, Tau2 = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.

Original languageEnglish (US)
Pages (from-to)2101-2118
Number of pages18
JournalAIDS and behavior
Volume16
Issue number8
DOIs
StatePublished - Nov 2012

Keywords

  • ART adherence
  • Alcohol
  • Depression
  • HIV
  • Systematic review

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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