TY - JOUR
T1 - Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
AU - Shearer, Kate
AU - Evans, Denise
AU - Xhosa, Barbara
AU - Hirasen, Kamban
AU - Bracken, Craig
AU - Mahomed, Kay
AU - Long, Lawrence
AU - Fox, Matthew P.
N1 - Publisher Copyright:
© 2018 Shearer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/9
Y1 - 2018/9
N2 - Background Depression is a leading cause of disability and may be associated with decreased adherence to ART. We sought to describe the prevalence of depressive symptoms and outcomes one year after screening among patients receiving ART at a large HIV Clinic in Johannesburg, South Africa. Methods Adult (≥18) patients who had been on first-line ART between 6-18 months who could communicate in English were eligible. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9 and a score ≥10 indicated depression. Results 97 patients enrolled. Patients had been on ART for a median (IQR) of 8 (7±10) months, 61% were female, the median (IQR) age at enrollment was 38 (33±42) years, and the median (IQR) CD4 count at ART initiation was 154.5 (65±263) cells/mm3. 7 (7%) patients were found to have symptoms of depression; 4 (4%) had symptoms of moderate depression (PHQ score of 10±14) and 3 (3%) had symptoms of moderate/severe depression (PHQ score of 15±19). Women (10%) were more likely to have symptoms of depression than men (3%; prevalence difference [PD]: 7.5%; 95% confidence interval [CI]:-1.7%-16.8%); as were patients under the age of 30 (14%) compared to those 30±39 (4%; PD: -10.2; 95% CI: -29.4±9.0%) or ≥40 (9%; PD: -5.5%; -26.1%-15.2%), those with lower CD4 counts at ART initiation (<200 cells/mm3 vs ≥200 cells/mm3: 8% vs 3%; PD: 4.8%; 95% CI: -4.5%-14.0%), and those with high viral loads (>1000 copies/mL vs. <400 copies/mL: 40% vs. 5%; PD: 34.6%; 95% CI: -8.6%-77.6%). No relationship between depressive symptoms and retention in HIV care one year after screening was observed. Conclusions We found a lower prevalence of depressive symptoms compared to findings from other HIVpositive populations in South Africa but more than one-third of patients with an elevated viral load had evidence of depression. Further research on the relationship between depression, adherence, and viral failure is warranted as this may present an opportunity for early interventions to improve treatment outcomes and reduce the need for second-line treatment.
AB - Background Depression is a leading cause of disability and may be associated with decreased adherence to ART. We sought to describe the prevalence of depressive symptoms and outcomes one year after screening among patients receiving ART at a large HIV Clinic in Johannesburg, South Africa. Methods Adult (≥18) patients who had been on first-line ART between 6-18 months who could communicate in English were eligible. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9 and a score ≥10 indicated depression. Results 97 patients enrolled. Patients had been on ART for a median (IQR) of 8 (7±10) months, 61% were female, the median (IQR) age at enrollment was 38 (33±42) years, and the median (IQR) CD4 count at ART initiation was 154.5 (65±263) cells/mm3. 7 (7%) patients were found to have symptoms of depression; 4 (4%) had symptoms of moderate depression (PHQ score of 10±14) and 3 (3%) had symptoms of moderate/severe depression (PHQ score of 15±19). Women (10%) were more likely to have symptoms of depression than men (3%; prevalence difference [PD]: 7.5%; 95% confidence interval [CI]:-1.7%-16.8%); as were patients under the age of 30 (14%) compared to those 30±39 (4%; PD: -10.2; 95% CI: -29.4±9.0%) or ≥40 (9%; PD: -5.5%; -26.1%-15.2%), those with lower CD4 counts at ART initiation (<200 cells/mm3 vs ≥200 cells/mm3: 8% vs 3%; PD: 4.8%; 95% CI: -4.5%-14.0%), and those with high viral loads (>1000 copies/mL vs. <400 copies/mL: 40% vs. 5%; PD: 34.6%; 95% CI: -8.6%-77.6%). No relationship between depressive symptoms and retention in HIV care one year after screening was observed. Conclusions We found a lower prevalence of depressive symptoms compared to findings from other HIVpositive populations in South Africa but more than one-third of patients with an elevated viral load had evidence of depression. Further research on the relationship between depression, adherence, and viral failure is warranted as this may present an opportunity for early interventions to improve treatment outcomes and reduce the need for second-line treatment.
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U2 - 10.1371/journal.pone.0203797
DO - 10.1371/journal.pone.0203797
M3 - Article
C2 - 30252844
AN - SCOPUS:85054031411
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 9
M1 - e0203797
ER -