The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa

Abstract

Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal, South Africa. Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded, semi-urban clinic in the eThekwini Municipal District, KwaZulu-Natal, South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D) and clinic-based pill counts, respectively. Socio-demographic and clinical data were collected during interviews and from patient records. Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale, and 32% were less than 95% adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.0–4.1] and unemployment (OR 2.8; 95% CI, 1.3–6.0), while non-adherence was associated with unemployment (OR 2.4; 95% CI, 1.0–6.1) and mid-range CD4 counts (200–499 cells/μl; OR 3.0; 95% CI, 1.3–6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95% CI, 0.2–1.2; p-value, 0.125). Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and nonadherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment, while non-adherence was associated with unemployment and mid-range CD4 counts (200–499 cells/μl). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world.