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

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.

References

  1. 1.
    World Health Organization. The 3 by 5 initiative. Geneva: WHO, 2003. Available at: http://www.who.int/3by5/en/. Accessed 2 July 2010.
  2. 2.
    Jahn A, Floyd S, Crampin AC, et al. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet. 2008;371:1603–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Reniers G, Araya T, Davey G, et al. Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia. AIDS. 2009;23:511–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Parienti JJ, Das-Douglas M, Massari V, et al. Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS One. 2008;3:e2783.PubMedCrossRefGoogle Scholar
  5. 5.
    Gill CJ, Hamer DH, Simon JL, Thea DM, Sabin LL. No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa. AIDS. 2005;19:1243–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Mills EJ, Nachega JB, Bangsberg, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3:e438.PubMedCrossRefGoogle Scholar
  7. 7.
    Bangsberg DR. Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. J Infect Dis. 2008;197:S272–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Arrivillaga M, Ross M, Useche B, Alzate ML, Correa D. Social position, gender role, and treatment adherence among Colombian women living with HIV/AIDS: social determinants of health approach. Rev Panam Salud Publica. 2009;26:502–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18:S19–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Gibbie T, Hay M, Hutchison CW, Mijch A. Depression, social support and adherence to highly active antiretroviral therapy in people living with HIV/AIDS. Sex Health. 2007;4:227–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Gibbie T, Mijch A, Ellen S, et al. Depression and neuro-cognitive performance in individuals with HIV/AIDS: 2-year follow-up. HIV Med. 2006;7:112–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Aloisi MS, Arici C, Balzano R, et al. Behavioral correlates of adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31:S145–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Nachega JB, Trotta MP, Nelson M, Ammassari A. Impact of metabolic complications on antiretroviral treatment adherence: clinical and public health implications. Curr HIV/AIDS Rep. 2009;6:121–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Nachega JB, Leisegang R, Bishai D, et al. Association of antiretroviral therapy adherence and health care costs. Ann Intern Med. 2010;152:18–25.PubMedGoogle Scholar
  15. 15.
    Veenstra N, Oyier A. The burden of HIV–related illness on outpatient health services in KwaZulu–natal, South Africa. AIDS Care. 2006;18:262–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Cruess DG, Evans DL, Repetto MJ, Gettes D, Douglas SD, Petitto JM. Prevalence, diagnosis, and pharmacological treatment of mood disorders in HIV disease. Biol Psychiatry. 2003;54:307–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Lazo M, Gange SJ, Wilson TE, et al. Patterns and predictors of changes in adherence to highly active antiretroviral therapy: longitudinal study of men and women. Clin Infect Dis. 2007;45:1377–85.PubMedCrossRefGoogle Scholar
  18. 18.
    Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58:721–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV cost and services utilization study. J Stud Alcohol. 2002;63:179–86.PubMedGoogle Scholar
  20. 20.
    Braithwaite RS, McGinnis KA, Conigliaro J, et al. A temporal and dose–response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29:1190–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Pence BW, Miller WC, Gaynes BN, Eron JJ Jr. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;44:159–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta–analysis. J Acquir Immune Defic Syndr. 2009;52:180–202.PubMedCrossRefGoogle Scholar
  23. 23.
    Rabkin JG. HIV and depression: 2008 review and update. Curr HIV/AIDS Rep. 2008;5:163–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17:756–65.PubMedCrossRefGoogle Scholar
  25. 25.
    Braithwaite RS, Conigliaro J, McGinnis KA, Maisto SA, Bryant K, Justice AC. Adjusting alcohol quantity for mean consumption and intoxication threshold improves prediction of non adherence in HIV patients and HIV-negative controls. Alcohol Clin Exp Res. 2008;32:1645–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20:1571–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Chander G, Himelhoch S, Moore RD. Substance abuse and psychiatric disorders in HIV positive patients: epidemiology and impact on antiretroviral therapy. Drugs. 2006;66:769–89.PubMedCrossRefGoogle Scholar
  28. 28.
    Hunter JE, Schmidt FL. Methods of meta-analysis: correcting error and bias in research findings. 2nd ed. Thousand Oaks: Sage; 2004.Google Scholar
  29. 29.
    Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRefGoogle Scholar
  30. 30.
    Rucker G, Schwarzer G, Carpenter JR, Schumacher M. Undue reliance on I (2) in assessing heterogeneity may mislead. BMC Med Res Methodol. 2008;8:79.PubMedCrossRefGoogle Scholar
  31. 31.
    Duval SJ, Tweedie RL (2000) Trim and fill: a simple funnel plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:276–284CrossRefGoogle Scholar
  32. 32.
    Comprehensive meta-analysis [computer program]. Version 2.0. Englewood: Biostat; 2009.Google Scholar
  33. 33.
    Adewuya AO, Afolabi MO, Ola BA, et al. Relationship between depression and quality of life in persons with HIV infection in Nigeria. Int J Psychiatry Med. 2008;38:43–51.PubMedCrossRefGoogle Scholar
  34. 34.
    Adewuya AO, Afolabi MO, Ola BA, et al. The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria. Psychosomatics. 2010;51:68–73.PubMedGoogle Scholar
  35. 35.
    Amberbir A, Woldemichael K, Getachew S, Girma B, Deribe K. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in southwest Ethiopia. BMC Public Health. 2008;8:265.PubMedCrossRefGoogle Scholar
  36. 36.
    Byakika-Tusiime J, Crane J, Oyugi JH, et al. Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-plus family treatment model: role of depression in declining adherence over time. AIDS Behav. 2009;13:S82–91.CrossRefGoogle Scholar
  37. 37.
    Cohen MH, Fabri M, Cai X, et al. Prevalence and predictors of posttraumatic stress disorder and depression in HIV-infected and at-risk Rwandan women. J Womens Health. 2009;18:1783–91.CrossRefGoogle Scholar
  38. 38.
    Do NT, Phiri K, Bussmann H, Gaolathe T, Marlink RG, Wester CW. Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana. AIDS Res Hum Retroviruses. 2010;26:685–91.PubMedCrossRefGoogle Scholar
  39. 39.
    Etienne M, Hossain M, Redfield R, Stafford K, Amoroso A. Indicators of adherence to antiretroviral therapy treatment among HIV/AIDS patients in 5 African countries. J Int Assoc Physicians AIDS Care (Chic Ill). 2010;9:98–103.CrossRefGoogle Scholar
  40. 40.
    Farley J, Miller E, Zamani A, et al. Screening for hazardous alcohol use and depressive symptomatology among HIV-infected patients in Nigeria: prevalence, predictors, and association with adherence. J Int Assoc Physicians AIDS Care (Chic). 2010;9:218–26.CrossRefGoogle Scholar
  41. 41.
    Kagee A, Martin L. Symptoms of depression and anxiety among a sample of South African patients living with HIV. AIDS Care. 2010;22:159–65.PubMedCrossRefGoogle Scholar
  42. 42.
    Kaharuza FM, Bunnell R, Moss S, et al. Depression and CD4 cell count among persons with HIV infection in Uganda. AIDS Behav. 2006;10:S105–11.PubMedCrossRefGoogle Scholar
  43. 43.
    Kekwaletswe C, Morojele N, Nkosi S. Depression, alcohol use and adherence to antiretroviral therapy (ART). Poster presented at the 6th International AIDS Society Conference on HIV Pathogenesis and Treatment. Rome; 2011 [Abstract].Google Scholar
  44. 44.
    Lawler K, Mosepele M, Seloilwe E, et al. Depression among HIV-positive individuals in Botswana: a behavioral surveillance. AIDS Behav. 2009;15:204–8.CrossRefGoogle Scholar
  45. 45.
    Martinez P, Andia I, Emenyonu N, et al. Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in southwest Uganda. AIDS Behav. 2008;12:605–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Marwick KF, Kaaya SF. Prevalence of depression and anxiety disorders in HIV-positive out patients in rural Tanzania. AIDS Care. 2010;22:415–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Monahan PO, Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24:189–97.PubMedCrossRefGoogle Scholar
  48. 48.
    Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22:147–58.PubMedCrossRefGoogle Scholar
  49. 49.
    Nachega J, Morroni C, Ram M, Efron E, Chaisson R, Maartens G. Impact of concurrent TB treatment on ART adherence and liver toxicity in South African adults. 18th Conference on retroviruses and opportunistic infection, Boston; 2011 [Poster#883].Google Scholar
  50. 50.
    Nakasujja N, Skolasky RL, Musisi S, et al. Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda. BMC Psychiatry. 2010;10:44.PubMedCrossRefGoogle Scholar
  51. 51.
    Nakimuli-Mpungu E, Mutamba B, Othengo M, Musisi S. Psychological distress and adherence to highly active anti-retroviral therapy (HAART) in Uganda: a pilot study. Afr Health Sci. 2009;9:S2–7.PubMedGoogle Scholar
  52. 52.
    Nakimuli–Mpungu E, Munyaneza G. Depression Alcohol abuse and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda. Neurobehav HIV Med. 2011;3:19–25.CrossRefGoogle Scholar
  53. 53.
    Olley BO, Seedat S, Stein DJ. Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: a 6-month follow-up study. J Psychosom Res. 2006;61:479–84.PubMedCrossRefGoogle Scholar
  54. 54.
    Patel R, Kassaye S, Gore-Felton C, et al. Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe. AIDS Care. 2009;21:1517–27.PubMedCrossRefGoogle Scholar
  55. 55.
    Pearson CR, Micek MA, Pfeiffer J, et al. One year after ART initiation: psychosocial factors associated with stigma among HIV-positive Mozambicans. AIDS Behav. 2009;13:1189–96.PubMedCrossRefGoogle Scholar
  56. 56.
    Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10:111.PubMedCrossRefGoogle Scholar
  57. 57.
    Poupard M, Ngom Gueye NF, Thiam D, et al. Quality of life and depression among HIV-infected patients receiving efavirenz- or protease inhibitor-based therapy in Senegal. HIV Med. 2007;8:92–5.PubMedCrossRefGoogle Scholar
  58. 58.
    Ramadhani HO, Thielman NM, Landman KZ, et al. Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania. Clin Infect Dis. 2007;45:1492–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape town, South Africa. Soc Sci Med. 2007;64:1823–31.PubMedCrossRefGoogle Scholar
  60. 60.
    Spies G, Kader K, Kidd M, et al. Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. AIDS Care. 2009;21:1163–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Wagner G, Holloway I, Ghosh-Dastidar B, Kityo C, Mugyenyi P. Understanding the influence of depression on self-efficacy, work status, and condom use among HIV clients in Uganda. J Psychosom Res. 2010;70:440–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Weidle PJ, Wamai N, Solberg P, et al. Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda. Lancet. 2006;368:1587–94.PubMedCrossRefGoogle Scholar
  63. 63.
    Tomlinson M, Grimsrud AT, Stein DJ, Williams DR, Myer L. The epidemiology of major depression in South Africa: results from the South African stress and health study. S Afr Med J. 2009;99:367–73.PubMedGoogle Scholar
  64. 64.
    Ovuga E, Boardman J, Wasserman D. The prevalence of depression in two districts of Uganda. Soc Psychiatry Psychiatr Epidemiol. 2005;40:439–45.PubMedCrossRefGoogle Scholar
  65. 65.
    Rothlind JC, Greenfield TM, Bruce AV, et al. Heavy alcohol consumption in individuals with HIV infection: effects on neuropsychological performance. J Int Neuropsychol Soc. 2005;11:70–83.PubMedCrossRefGoogle Scholar
  66. 66.
    Murphy DA, Greenwell L, Hoffman D. Factors associated with antiretroviral adherence among HIV-infected women with children. Women Health. 2002;36:97–111.PubMedCrossRefGoogle Scholar
  67. 67.
    Mbulaiteye SM, Ruberantwari A, Nakiyingi JS, Carpenter LM, Kamali A, Whitworth JA. Alcohol and HIV: a study among sexually active adults in rural southwest Uganda. Int J Epidemiol. 2000;29:911–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Shaffer DN, Njeri R, Justice AC, Odero WW, Tierney WM. Alcohol abuse among patients with and without HIV infection attending public clinics in western Kenya. East Afr Med J. 2004;81:594–8.PubMedGoogle Scholar
  69. 69.
    Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8:141–51.PubMedCrossRefGoogle Scholar
  70. 70.
    Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47:384–90.PubMedCrossRefGoogle Scholar
  71. 71.
    Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2009;13:60–5.PubMedCrossRefGoogle Scholar
  72. 72.
    Flaherty JA, Gaviria FM, Pathak D, et al. Developing instruments for cross-cultural psychiatric research. J Nerv Ment Dis. 1998;176:257–63.Google Scholar
  73. 73.
    Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.PubMedCrossRefGoogle Scholar
  74. 74.
    Bass JK, Bolton PA, Murray LK. Do not forget culture when studying mental health. Lancet. 2007;370:918–95.PubMedCrossRefGoogle Scholar
  75. 75.
    WHO Brief Intervention Study Group. A cross-national trial of brief intervention with heavy drinkers. Am J Public Health. 1996;86:948–55.CrossRefGoogle Scholar
  76. 76.
    Bass J, Neugebauer R, Clougherty KF, et al. Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: randomised controlled trial. Br J Psychiatry. 2006;188:567–73.PubMedCrossRefGoogle Scholar

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

Personalised recommendations