AIDS and Behavior

, Volume 16, Issue 8, pp 2101–2118 | Cite as

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

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


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.


Depression Alcohol HIV ART adherence Systematic review 


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.



This paper was presented at the IAPAC-NIH/NIMH 6th International Conference on HIV Treatment and Prevention Adherence, May 22–24, 2011, Miami, Florida, USA. Oral Abstract # 70490. We thank Joanna Downer, PhD, for critical reading and editing of this manuscript as well as Ms. Sharon Blackburn, Olalekan Uthman, PhD, and Huh-Shan Ho, PhD, for assisting with the final formatting and editing of the figures and Tables.

Grant Support

The International Fulbright Science and Technology Award (ENM). The US National Institutes for Allergy and Infectious Disease (NIAID-NIH), Division of AIDS (DAIDS): K23 AI 068582-01 (JBN); The US NIH-FIC/HRSA PEPFAR Grant Award, T84HA21652-01-00 for Medical Education Partnership Initiative (MEPI) (JBN); The European Developing Countries Clinical Trial Partnership (EDCTP) Senior Fellowship Award: TA-08-40200-021 (JBN); The Wellcome Trust Southern Africa Consortium for Research Excellence (SACORE): WT087537MA (JBN); the NIMH-NIH R34 MH083592-01A1 (EJM).


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Etheldreda Nakimuli-Mpungu
    • 1
    • 2
    Email author
  • 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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