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Depression, ART Adherence, and Receipt of Case Management Services by Adults with HIV in North Carolina, Medical Monitoring Project, 2009–2013

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Abstract

Depression among persons with HIV is associated with antiretroviral therapy (ART) interruption and discontinuation, virological failure, and poor clinical and survival outcomes. Case management services can address needs for emotional counseling and other supportive services to facilitate HIV care engagement. Using 2009–2013 North Carolina Medical Monitoring Project data from 910 persons engaged in HIV care, we estimated associations of case management utilization with “probable current depression” and with 100% ART dose adherence. After weighting, 53.2% of patients reported receiving case management, 21.7% reported depression, and 87.0% reported ART adherence. Depression prevalence was higher among those reporting case management (24.9%) than among other patients (17.6%) (p < 0.01). Case management was associated with depression among patients living above the poverty level [adjusted prevalence ratio (aPR), 2.05; 95% confidence interval (CI) 1.25–3.36], and not among other patients (aPR, 1.01; 95% CI 0.72–1.43). Receipt of case management was not associated with ART adherence (aPR, 1.00; 95% CI 0.95–1.05). Our analysis indicates a need for more effective depression treatment, even among persons receiving case management services. Self-reported ART adherence was high overall, though lower among persons experiencing depression (unadjusted prevalence ratio, 0.92; 95% CI 0.86–0.99). Optimal HIV clinical and prevention outcomes require addressing psychological wellbeing, monitoring of ART adherence, and effective case management services.

Resumen

La depresión en personas con VIH está asociada con la interrupción y descontinuación de terapia antirretroviral (TAR), fallo virológico, y resultados clínicos y de sobrevivencia deficientes. Los servicios de atención individualizada pueden abordar las necesidades de consejería emocional y otros servicios de apoyo para facilitar el enlace y cuidado del VIH. Con el uso datos del North Carolina Medical Monitoring Project (Proyecto del Monitoreo Médico de Carolina del Norte, MMP – por sus siglas en inglés) de 2009-2013, de 910 personas recibiendo cuidado para el VIH, estimamos asociaciones entre el uso de atención individualizada y “depresión actual probable” con 100% de cumplimiento de TAR. Después de ponderación, 53.2% de pacientes reportaron recibir atención individualizada, 21.7% reportaron depresión, y 87.0% reportaron cumplimiento con TAR. La prevalencia de depresión resultó ser más alta en aquellos reportando atención individualizada (24.9%) que en otros pacientes (17.6%) (p < 0.01). Hubo una asociación entre la atención individualizada y depresión en pacientes viviendo arriba del nivel de pobreza [tasa de prevalencia ajustada (aPR, 1.01; 95% intervalo de confianza (IC), 1.25-3.36], y no en otros pacientes (aPR, 1.01; 95% IC 0.72-1.43). No hubo asociación entre la recepción de atención individualizada y cumplimiento con TAR (aPR, 1.00; 95% IC 0.95-1.05). Nuestro análisis indica una necesidad para el tratamiento de depresión más efectivo, aún en personas recibiendo atención individualizada. Cumplimiento con TAR auto reportado resultó ser elevado generalmente, aunque bajo en personas enfrentando depresión (tasa de prevalencia no corregida, 0.92; 95% IC, 0.86-0.99). Resultados clínicos y de prevención de VIH óptimos requieren abordar el bienestar psicológico, monitoreo de cumplimiento con TAR, y servicios de atención individualizada efectivos.

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Acknowledgments

The authors would like to thank the following individuals at the North Carolina Department of Health and Human Services, Public Health Division, Communicable Disease Branch for conceptual insight and assistance with procuring data: Jacquelyn Clymore, MS, Jenni Wheeler, MPH, Brad Wheeler, MSPH, Mark Turner, MPH, Kearston Ingraham, MPH, and Jason Maxwell, BS. We owe our gratitude to Paul Camarena, MA, CHES and The Institute for Global Health and Infectious Diseases for assistance with translation to Spanish. We would also like to thank Chris Wiesen, Ph.D. and The UNC Odum Institute for Research in Social Science for statistical guidance.

Funding

Funding for the North Carolina Medical Monitoring Project is provided by a Cooperative Agreement (PS09-937) between the CDC and the NC Department of Health and Human Services.

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA

    Damon F. Ogburn, Victor J. Schoenbach, Andrew Edmonds, Brian W. Pence & Kimberly A. Powers

  2. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA

    Becky L. White

  3. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA

    Becky L. White

  4. North Carolina Department of Health and Human Services, Division of Public Health, Communicable Disease Branch, Raleigh, NC, 27603, USA

    Nicole Dzialowy & Erika Samoff

  5. Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA

    Damon F. Ogburn

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Correspondence to Damon F. Ogburn.

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The authors declare that they have no conflict of interest.

Ethical Approval

The Centers for Disease Control and Prevention determined that the Medical Monitoring Project is a public health surveillance activity. MMP itself is therefore not subject to human subjects regulations including federal institutional review board review. The IRB at the University of North Carolina at Chapel Hill determined that these analyses were exempt from full review (UNC IRB #14-2675).

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Ogburn, D.F., Schoenbach, V.J., Edmonds, A. et al. Depression, ART Adherence, and Receipt of Case Management Services by Adults with HIV in North Carolina, Medical Monitoring Project, 2009–2013. AIDS Behav 23, 1004–1015 (2019). https://doi.org/10.1007/s10461-018-2365-1

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