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Declining Prevalence of Probable Depression Among Patients Presenting for Antiretroviral Therapy in Rural Uganda: The Role of Early Treatment Initiation

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Abstract

Little is known about trends in depression at antiretroviral therapy (ART) initiation among people living with HIV (PLHIV) in low- and middle-income countries. We used data from an ongoing cohort of treatment-naïve PLHIV in rural Uganda to estimate secular trends in depression among PLHIV at ART initiation. We fitted linear regression models with depression symptom severity as the outcome variable and year of cohort entry (2005–2012) as the explanatory variable, adjusting for socio-demographic variables and assessing physical health score, body mass index (BMI), and CD4 count as potential mediators of a secular trend in depression symptom severity. There was a statistically significant negative association between year of entry and depression symptom severity, suggesting a 3.1 % relative decline in the mean depression symptom severity score at ART initiation in each year of study recruitment after the first year. This trend remained statistically significant after inclusion of baseline socio-demographic characteristics to the model and appeared to be driven by improved physical health scores, but not CD4 count or BMI.

Resumen

Poco se sabe acerca de las tendencias de la depresión en el inicio de la terapia antirretroviral (TAR) entre las personas que viven con VIH (PVVIH) en los países de bajos y medianos ingresos. Utilizamos datos de una cohorte en curso de PVVIH sin terapia antirretroviral previo de Uganda rural para estimar las tendencias seculares en la depresión entre PVVIH en el inicio del TAR. Hemos implementado modelos de regresión lineal, utilizando como variable de resultado la severidad de los síntomas de depresión y como variable explicativa, el año de entrada cohorte (2005–2012), ajustándolos a variables sociodemográficas y evaluando la puntuación de la salud física, índice de masa corporal (IMC) y el recuento de CD4 como mediadores potenciales de una tendencia secular en la severidad de los síntomas de depresión. Se observó una asociación negativa estadísticamente significativa entre el año de la entrada y la severidad de los síntomas de depresión, lo que sugiere una disminución relativa del 3,1 % en la puntuación media de los síntomas de depresión de gravedad en el inicio del TAR en cada año de la contratación del estudio después del primer año. Esta tendencia se mantuvo estadísticamente significativa después de la inclusión de las características sociodemográficas de base para el modelo y parece que el cambio fue impulsado por la mejora de resultados de salud física, pero no por el recuento de CD4 o IMC.

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Acknowledgments

We thank the participants of the Uganda AIDS Rural Treatment Outcomes Study who contributed valuable time and information. The UARTO Study was funded by U.S. National Institutes of Health (NIH) R01MH054907 and P30AI27763. The authors also acknowledge the following additional sources of support: NIH T32AI007433 (Chan), K23MH079713 (Weiser), K23MH087228 (Haberer), U01CA066529 (Martin), K24MH087227 (Bangsberg), K23MH096620 (Tsai), David Brudnoy Scholar Award (Chan), MGH Center for Global Health Travel Award (Chan), Partners Global Health Center of Expertise Travel Grant (Chan), and the Burke Family Foundation (Weiser).

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Authors and Affiliations

  1. Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street GRJ 504, 02114-2696, Boston, MA, USA

    Brian T. Chan

  2. Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA

    Brian T. Chan

  3. Harvard Medical School, Boston, MA, USA

    Brian T. Chan, Jessica E. Haberer, David R. Bangsberg & Alexander C. Tsai

  4. Division of HIV/AIDS, San Francisco General Hospital, University of California at San Francisco (UCSF), San Francisco, CA, USA

    Sheri D. Weiser & Peter W. Hunt

  5. Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA

    Sheri D. Weiser

  6. Epicentre, Mbarara, Uganda

    Yap Boum

  7. Massachusetts General Hospital Center for Global Health, Boston, MA, USA

    Jessica E. Haberer, David R. Bangsberg & Alexander C. Tsai

  8. Mbarara University of Science and Technology, Mbarara, Uganda

    Annet Kembabazi, David R. Bangsberg & Alexander C. Tsai

  9. Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA

    Jeffrey N. Martin & A. Rain Mocello

  10. Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

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  1. Brian T. Chan
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Correspondence to Brian T. Chan.

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Chan, B.T., Weiser, S.D., Boum, Y. et al. Declining Prevalence of Probable Depression Among Patients Presenting for Antiretroviral Therapy in Rural Uganda: The Role of Early Treatment Initiation. AIDS Behav 19, 19–26 (2015). https://doi.org/10.1007/s10461-014-0785-0

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