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Effects of Depression, Stigma and Intimate Partner Violence on Postpartum Women’s Adherence and Engagement in HIV Care in Kenya

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Abstract

We explored the association between HIV-related stigma and experiences of intimate partner violence (IPV) and depression with viral load suppression, and medication and visit adherence in postpartum women receiving lifelong antiretroviral therapy (ART) (N = 200). We administered a cross-sectional survey to 200 women with HIV at 12 months postpartum who were enrolled in the MOTIVATE trial. The MOTIVATE study is a cluster-randomized trial evaluating the impact of community mentor mothers and text messaging on PMTCT outcomes in southwestern Kenya. Simple and multivariable logistic regression analysis was performed in STATA. Women who experienced stigma or IPV were more likely to miss clinic visits (internalized stigma aOR 1.30 95%CI 1.03–1.64; anticipated stigma aOR 1.20 95%CI 1.04–1.42; IPV aOR 15.71 95%CI 1.47–167.80), report difficulty taking ART drugs (internalized stigma aOR 1.32 95%CI 1.10–1.58; anticipated stigma aOR 1.14 95%CI 1.01–1.30) and not taking medication as prescribed (IPV aOR 2.00 95%CI 1.05–3.74). Depression was additionally associated with decreased odds of viral load suppression (aOR 0.16 95%CI 0.04–0.76). There is need to develop tailored psychosocial interventions within PMTCT programs that appropriately address mental health, stigma, and violence.

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References

  1. Orza L, Bewley S, Chung C, Crone ET, Nagadya H, Vazquez M, et al. “Violence. Enough already”: findings from a global participatory survey among women living with HIV. J Int AIDS Soc. 2015;18(Suppl 5):20285.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Narasimhan M, Orza L, Welbourn A, Bewley S, Crone T, Vazquez M. Sexual and reproductive health and human rights of women living with HIV: a global community survey. Bull World Health Organ. 2016;94(4):243–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Orza L, Bewley S, Logie CH, Crone ET, Moroz S, Strachan S, et al. How does living with HIV impact on women’s mental health? Voices from a global survey. J Int AIDS Soc. 2015;18(Suppl 5):20289.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kohler PK, Ondenge K, Mills LA, Okanda J, Kinuthia J, Olilo G, et al. Shame, guilt, and stress: Community perceptions of barriers to engaging in prevention of mother to child transmission (PMTCT) programs in western Kenya. AIDS Patient Care STDs. 2014;28(12):643–51.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Turan JM, Nyblade L. Global maternal and child health goals will not be achieved without addressing HIV-related stigma. J Acquir Immune Defic Syndr. 2013;64(1):e9–10.

    Article  PubMed  Google Scholar 

  6. Mitchell J, Wight M, Van Heerden A, Rochat TJ. Intimate partner violence, HIV, and mental health: a triple epidemic of global proportions. Int Rev Psychiatry (Abingdon, Engl). 2016;28(5):452–63.

    Article  Google Scholar 

  7. Shamu S, Abrahams N, Temmerman M, Musekiwa A, Zarowsky C. A systematic review of African studies on intimate partner violence against pregnant women: prevalence and risk factors. PLoS ONE. 2011;6(3):e17591.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Turan B, Stringer KL, Onono M, Bukusi EA, Weiser SD, Cohen CR, et al. Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study. BMC Pregnancy Childbirth. 2014;14:400.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sowa NA, Cholera R, Pence BW, Gaynes BN. Perinatal depression in HIV-infected African women: a systematic review. J Clin Psychiatry. 2015;76(10):1385–96.

    Article  PubMed  Google Scholar 

  10. Campbell JC, Baty ML, Ghandour RM, Stockman JK, Francisco L, Wagman J. The intersection of intimate partner violence against women and HIV/AIDS: a review. Int J Injury Control Saf Promot. 2008;15(4):221–31.

    Article  CAS  Google Scholar 

  11. Asch SM, Kilbourne AM, Gifford AL, Burnam MA, Turner B, Shapiro MF, et al. Underdiagnosis of depression in HIV: who are we missing? J Gen Intern Med. 2003;18(6):450–60.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Turan JM, Nyblade L. HIV-related stigma as a barrier to achievement of global PMTCT and maternal health goals: a review of the evidence. AIDS Behav. 2013;17(7):2528–39.

    Article  PubMed  Google Scholar 

  13. Knettel BA, Cichowitz C, Ngocho JS, Knippler ET, Chumba LN, Mmbaga BT, et al. Retention in HIV care during pregnancy and the postpartum period in the Option B+ era: systematic review and meta-analysis of studies in Africa. J Acquir Immune Defic Syndr. 2018;77(5):427–38.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16(8):2101–18.

    Article  PubMed  Google Scholar 

  15. Hampanda KM. Intimate partner violence and HIV-positive women’s non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia. Soc Sci Med. 1982;2016(153):123–30.

    Google Scholar 

  16. Matheson R, Moses-Burton S, Hsieh AC, Dilmitis S, Happy M, Sinyemu E, et al. Fundamental concerns of women living with HIV around the implementation of Option B+. J Int AIDS Soc. 2015;18(Suppl 5):20286.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Phiri S, Tweya H, van Lettow M, Rosenberg NE, Trapence C, Kapito-Tembo A, et al. Impact of facility- and community-based peer support models on maternal uptake and retention in Malawi’s Option B+ HIV prevention of mother-to-child transmission program: a 3-arm cluster randomized controlled trial (PURE Malawi). J Acquir Immune Defic Syndr. 1999;2017(75 Suppl 2):S140–8.

    Google Scholar 

  18. Odeny TA, Onono M, Owuor K, Helova A, Wanga I, Bukusi EA, et al. Maximizing adherence and retention for women living with HIV and their infants in Kenya (MOTIVATE! study): study protocol for a randomized controlled trial. Trials. 2018;19(1):77.

    Article  PubMed  PubMed Central  Google Scholar 

  19. National AIDS Control Council. Kenya HIV estimates: report 2018. Nairobi: Ministry of Health; 2018.

    Google Scholar 

  20. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  21. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1–3):163–73.

    Article  PubMed  Google Scholar 

  22. Cholera R, Gaynes BN, Pence BW, Bassett J, Qangule N, Macphail C, et al. Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kroenke K, Spitzer RL, Williams JB, Lowe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59.

    Article  PubMed  Google Scholar 

  24. International Parenthood Federation (IPF), Global Network of People Living with HIV (GNP+), International Community of Women Living with HIV (ICW), UNAIDS. The people living with HIV Stigma Index: an index to measure the stigma and discrimination experienced by people living with HIV. London: International Parenthood Federation; 2008.

    Google Scholar 

  25. Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav. 2011;15(6):1111–20.

    Article  PubMed  Google Scholar 

  26. Weiser SD, Heisler M, Leiter K, Percy-de Korte F, Tlou S, DeMonner S, et al. Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS Med. 2006;3(7):e261.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Siedner MJ, Tsai AC, Dworkin S, Mukiibi NF, Emenyonu NI, Hunt PW, et al. Sexual relationship power and malnutrition among HIV-positive women in rural Uganda. AIDS Behav. 2012;16(6):1542–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schuster TL, Kessler RC, Aseltine RH. Supportive interactions, negative interactions, and depressed mood. Am J Community Psychol. 1990;18(3):423–38.

    Article  CAS  PubMed  Google Scholar 

  29. Turner RJ, Frankel BG, Levin DM. Social support: conceptualization, measurement, and implications for mental health. Res Community Mental Health. 1983;3:67–111.

    Google Scholar 

  30. National AIDS and STI Control Programme. Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya. Nairobi: National AIDS & STI Control Program, Ministry of Health Kenya; 2018.

    Google Scholar 

  31. Devries KM, Mak JYT, García-Moreno C, Petzold M, Child JC, Falder G, et al. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–8.

    Article  CAS  PubMed  Google Scholar 

  32. Shamu S, Abrahams N, Zarowsky C, Shefer T, Temmerman M. Intimate partner violence during pregnancy in Zimbabwe: a cross-sectional study of prevalence, predictors and associations with HIV. Trop Med Int Health. 2013;18(6):696–711.

    Article  PubMed  Google Scholar 

  33. Belenky NM, Cole SR, Pence BW, Itemba D, Maro V, Whetten K. Depressive symptoms, HIV medication adherence, and HIV clinical outcomes in Tanzania: a prospective, observational study. PLoS ONE. 2014;9(5):e95469.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Peltzer K, Rodriguez VJ, Jones D. Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa. SAHARA J. 2016;13(1):60–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Evans DL, Leserman J, Pedersen CA, Golden RN, Lewis MH, Folds JA, et al. Immune correlates of stress and depression. Psychopharmacol Bull. 1989;25(3):319–24.

    CAS  PubMed  Google Scholar 

  36. Bouhnik AD, Preau M, Vincent E, Carrieri MP, Gallais H, Lepeu G, et al. Depression and clinical progression in HIV-infected drug users treated with highly active antiretroviral therapy. Antiviral Ther. 2005;10(1):53–61.

    Article  CAS  Google Scholar 

  37. Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC, Richardson JL, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004;94(7):1133–40.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ickovics JR, Hamburger ME, Vlahov D, Schoenbaum EE, Schuman P, Boland RJ, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001;285(11):1466–74.

    Article  CAS  PubMed  Google Scholar 

  39. Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, et al. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16(3):711–6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hatcher AM, Woollett N, Pallitto CC, Mokoatle K, Stockl H, MacPhail C, et al. Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission. J Int AIDS Soc. 2014;17:19233.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lopez EJ, Jones DL, Villar-Loubet OM, Arheart KL, Weiss SM. Violence, coping, and consistent medication adherence in HIV-positive couples. AIDS Educ Prev. 2010;22(1):61–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hatcher AM, Smout EM, Turan JM, Christofides N, Stockl H. Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis. AIDS (London, England). 2015;29(16):2183–94.

    Article  Google Scholar 

  43. Awiti Ujiji O, Ekstrom AM, Ilako F, Indalo D, Wamalwa D, Rubenson B. Reasoning and deciding PMTCT-adherence during pregnancy among women living with HIV in Kenya. Culture Health Sex. 2011;13(7):829–40.

    Article  Google Scholar 

  44. Spangler SA, Onono M, Bukusi EA, Cohen CR, Turan JM. HIV-positive status disclosure and use of essential PMTCT and maternal health services in rural Kenya. J Acquir Immune Defic Syndr. 2014;67(Suppl 4):s235–42.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Onono MA, Cohen CR, Jerop M, Bukusi EA, Turan JM. HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya. BMC Public Health. 2014;14:390.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Msuya SE, Mbizvo EM, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care. 2008;20(6):700–9.

    Article  CAS  PubMed  Google Scholar 

  47. Akama E, Mburu M, Mutegi E, Nyanaro G, Otieno JP, Ndolo S, et al. Impact of a rapid results initiative approach on improving male partner involvement in prevention of mother to child transmission of HIV in Western Kenya. AIDS Behav. 2018;22(9):2956–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3 Suppl 2):18640.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Tsai AC, Bangsberg DR, Kegeles SM, Katz IT, Haberer JE, Muzoora C, et al. Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Ann Behav Med. 2013;46(3):285–94.

    Article  PubMed  Google Scholar 

  50. Turan JM, Hatcher AH, Medema-Wijnveen J, Onono M, Miller S, Bukusi EA, et al. The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study. PLoS Med. 2012;9(8):e1001295.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Chan BT, Tsai AC, Siedner MJ. HIV treatment scale-up and HIV-related stigma in sub-Saharan Africa: a longitudinal cross-country analysis. Am J Public Health. 2015;105(8):1581–7.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Medema-Wijnveen JS, Onono M, Bukusi EA, Miller S, Cohen CR, Turan JM. How perceptions of HIV-related stigma affect decision-making regarding childbirth in rural Kenya. PLoS ONE. 2012;7(12):e51492.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgement

We thank the Kenyan women who participated in this cross-sectional survey and the research assistants who collected the data. We acknowledge the support of the Kenya Medical Research Institute (KEMRI), the Director of KEMRI and the Director of the Centre for Microbiology Research (CMR). Funding for the MOTIVATE! study is supported by Award Number R01HD080477 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (USA). Funding for the sub-study was supported by Award Number 4T32AI007447 from the National Institute of Allergy and Infectious Diseases (NIAID). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, NIAID or the NIH. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464-00202, Nairobi, Kenya

    Maricianah Onono, Tobias Odwar, Kevin Owuor & Elizabeth Bukusi

  2. Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA

    Lisa Abuogi

  3. Center for Global Health, Colorado School of Public Health, Aurora, CO, USA

    Lisa Abuogi & Karen Hampanda

  4. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Anna Helova & Janet Turan

  5. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Karen Hampanda

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  1. Maricianah Onono
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Correspondence to Maricianah Onono.

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Ethical Approval

The ethics committees of the Kenya Medical Research Institute, the University of Colorado Denver and the University of Alabama at Birmingham gave scientific and ethical approval for the study. Informed consent was obtained prior to commencement of all study procedures including administration of the survey questionnaire. Research assistants referred women who reported violence or depression for follow-up and referrals to services.

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Onono, M., Odwar, T., Abuogi, L. et al. Effects of Depression, Stigma and Intimate Partner Violence on Postpartum Women’s Adherence and Engagement in HIV Care in Kenya. AIDS Behav 24, 1807–1815 (2020). https://doi.org/10.1007/s10461-019-02750-y

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