AIDS and Behavior

, Volume 21, Issue 6, pp 1632–1640 | Cite as

Depression and Engagement in Care Among Newly Diagnosed HIV-Infected Adults in Johannesburg, South Africa

  • R. CholeraEmail author
  • B. W. Pence
  • B. N. Gaynes
  • J. Bassett
  • N. Qangule
  • A. Pettifor
  • C. Macphail
  • W. C. Miller
Original Paper


Delayed engagement in HIV care threatens the success of HIV treatment programs in sub-Saharan Africa and may be influenced by depression. We examined the relationship between depression prior to HIV diagnosis and engagement in HIV care at a primary care clinic in Johannesburg, South Africa. We screened 1683 patients for depression prior to HIV testing using the Patient Health Questionnaire-9. Among patients who tested positive for HIV we assessed linkage to HIV care, defined as obtaining a CD4 count within 3 months. Among those who linked to care and were eligible for ART, we assessed ART initiation within 3 months. Multivariable Poisson regression with a robust variance estimator was used to assess the association between depression and linkage to care or ART initiation. The prevalence of HIV was 26 % (n = 340). Among HIV-infected participants, the prevalence of depression was 30 %. The proportion of linkage to care was 80 % among depressed patients and 73 % among patients who were not depressed (risk ratio 1.08; 95 % confidence interval 0.96, 1.23). Of the participants who linked to care, 81 % initiated ART within 3 months in both depressed and not depressed groups (risk ratio 0.99; 95 % confidence interval 0.86, 1.15). Depression was not associated with engagement in HIV care in this South African primary care setting. Our unexpected findings suggest that some depressed HIV-infected patients might be more likely to engage in care than their counterparts without depression, and highlight the complex relationship between depression and HIV infection. These findings have led us to propose a new framework relating HIV infection, depression, and the population under study.


Depression HIV Engagement in care Africa 



The authors wish to thank the data collection team- Happiness Ndobe, Mpho Mbulaheni, Nonhlanhla Msimango, and Victor Lerato. We thank Dr. Annelies Van Rie for her guidance and support in implementing the study. We are also deeply grateful to the patients and staff at Witkoppen Health and Welfare Center.


This work was supported by the National Institute of Mental Health grant 5F30MH096664, and National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium comprised of the University of North Carolina, John Hopkins, Morehouse and Tulane (1R25TW009340-01) and the American Recovery and Reinvestment Act. Financial support for REDCAP was provided by Grant UL1RR025747 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the University of North Carolina and the Human Research Ethics Committee at the University of Witwatersrand and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • R. Cholera
    • 1
    Email author
  • B. W. Pence
    • 2
  • B. N. Gaynes
    • 3
  • J. Bassett
    • 4
  • N. Qangule
    • 4
  • A. Pettifor
    • 2
  • C. Macphail
    • 5
    • 6
  • W. C. Miller
    • 2
    • 7
  1. 1.UNC School of MedicineChapel HillUSA
  2. 2.Department of EpidemiologyUniversity of North Carolina Gillings School of Global Public HealthChapel HillUSA
  3. 3.Department of PsychiatryUNC School of MedicineChapel HillUSA
  4. 4.Witkoppen Health and Welfare CenterJohannesburgSouth Africa
  5. 5.Collaborative Research Network for Mental Health and Well-being in Rural CommunitiesUniversity of New EnglandArmidaleAustralia
  6. 6.Wits Reproductive Health and HIV InstituteUniversity of the WitwatersrandJohannesburgSouth Africa
  7. 7.Department of MedicineUNC School of MedicineChapel HillUSA

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