AIDS and Behavior

, Volume 16, Issue 8, pp 2101–2118

Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review

  • Etheldreda Nakimuli-Mpungu
  • Judith K. Bass
  • Pierre Alexandre
  • Edward J. Mills
  • Seggane Musisi
  • Malathi Ram
  • Elly Katabira
  • Jean B. Nachega
Substantive Review
First Online:

Abstract

This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5–38.2%, Tau2 = 0.23) and 18% (95% CI 12.3–25.8%, Tau2 = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31–0.66, Tau2 = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.

Keywords

Depression Alcohol HIV ART adherence Systematic review 

Resumen

Este estudio evaluó las estimaciones de los síntomas de depresión, depresión mayor, el consumo de alcohol o de trastornos y su relación con la adherencia antirretroviral en el África subsahariana. Estudios publicados entre Enero 1 de 2006 y Julio 31 de 2011 que documentaron estos problemas de salud mental fueron identificados a través de bases de datos electrónicas. Un análisis combinado de 23 estudios que informan tasas de síntomas de depresión y seis estudios que informan tasas de depresión mayor indican una estimación combinada del 31,2%, (95% CI, 25.5–38.2%; Tau2 = 0,23) y el 18% (IC 95%: 12.3–25.8%; Tau2 = 0.19) respectivamente. Pocos estudios informaron las tasas de consumo de alcohol o trastornos, por lo que no se agruparon sus estimaciones. Probabilidad de lograr una buena adherencia fue del 55% menor entre aquellos con síntomas de depresión en comparación con aquellos sin (OR combinado = 0.45 (IC 95% 0.31–0.66), Tau2 = 0,20, P valor = 0,000) Intervenciones para mejorar la salud mental de los individuos VIH positivos y apoyar la adhesión son necesarias urgentemente en África subsahariana.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Etheldreda Nakimuli-Mpungu
    • 1
    • 2
  • Judith K. Bass
    • 1
  • Pierre Alexandre
    • 1
  • Edward J. Mills
    • 3
  • Seggane Musisi
    • 2
  • Malathi Ram
    • 4
  • Elly Katabira
    • 6
  • Jean B. Nachega
    • 4
    • 5
    • 7
  1. 1.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of PsychiatryMakerere University College of Health SciencesKampalaUganda
  3. 3.Centre for Excellence in AIDS CareUniversity British of ColumbiaVancouverCanada
  4. 4.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.Department of Internal MedicineMakerere University College of Health SciencesKampalaUganda
  7. 7.Department of Medicine and Centre for Infectious Diseases, Faculty of Health SciencesStellenbosch UniversityCape TownSouth Africa

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