Risk Factors for Viral Non-Suppression among People Living with HIV and Major Depressive Disorder in Uganda
Risk Factors for Viral Non-Suppression among People Living with HIV and Major Depressive Disorder in Uganda作者机构：African Field Epidemiology Network Kampala Uganda Uganda Public Health Fellowship Program Kampala Uganda Ministry of Health Butabika National Referral Mental Hospital Kampala Uganda Department of Psychiatry College of Health Sciences Makerere University Kampala Uganda The AIDS Support Organization (TASO) Kampala Uganda Department of Mental Health Bloomberg’s School of Public Health Johns Hopkins University Baltimore USA Departments of Epidemiology Infectious Diseases and Microbiology Graduate School of Public Health University of Pittsburgh Pittsburgh USA Center for Infectious Disease Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa Departments of International Health and Epidemiology Bloomberg’s School of Public Health Johns Hopkins University Baltimore USA Department of Clinical Epidemiology & Biostatistics McMaster University Hamilton Canada
出 版 物：《World Journal of AIDS》 (艾滋病（英文）)
年 卷 期：2022年第12卷第2期
页 面：43-54页
学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 100401[医学-流行病与卫生统计学] 10[医学]
主 题：Depression Suicide Risk Anti-Retroviral Therapy Viral Suppression Uganda
摘 要：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 (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.
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