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Depression and ART Initiation Among HIV Serodiscordant Couples in Kenya and Uganda

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Abstract

Depression is a known barrier for antiretroviral therapy (ART) adherence, but less is understood about its effects on ART initiation. We followed 1013 HIV-infected individuals participating in the Partners Demonstration Project, an open-label study of integrated pre-exposure prophylaxis (PrEP) and ART delivery for HIV serodiscordant couples in Kenya and Uganda. Associations between depression, measured annually with the Hopkins Symptoms Checklist-Depression (HSCL-D), and ART initiation were assessed with Cox proportional hazards regression. At enrollment, 162 participants (16.0%) reported symptoms consistent with probable depression, defined by a HSCL-D mean score >1.75, and this proportion decreased during study follow-up (6.7 and 3.6% at 12- and 24-months, respectively; p value < 0.001). Greater depressive symptom severity was associated with a greater likelihood of ART initiation overall (adjusted hazard ratio [aHR] 1.32, 95% CI 1.01–1.73) and among participants with CD4 count ≤ 350 cells/µl (aHR 1.30, 95% CI 1.01–1.67). Depression decreased 6 months after ART initiation (adjusted odds ratio [aOR] 0.34, 95% CI 0.23–0.51). Among East African HIV-infected persons in HIV serodiscordant couples, depression was not a barrier to ART initiation. ART initiation was associated with improved depressive symptoms in this setting.

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Acknowledgments

The authors thank the couples who participated in the study and the teams at the four study sites and the University of Washington that supported data collection and management for this work.

Partners Demonstration Project Team

Coordinating Center (University of Washington) and collaborating investigators (Harvard Medical School, Johns Hopkins University, Massachusetts General Hospital): Jared Baeten (protocol chair), Connie Celum (protocol co-chair), Renee Heffron (project director), Deborah Donnell (statistician), Ruanne Barnabas, Jessica Haberer, Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware, Monique Wyatt. Project sites: Kabwohe, Uganda (Kabwohe Clinical Research Centre): Stephen Asiimwe, Edna Tindimwebwa

Kampala, Uganda (Makerere University): Elly Katabira, Nulu Bulya

Kisumu, Kenya (Kenya Medical Research Institute): Elizabeth Bukusi, Josephine Odoyo

Thika, Kenya (Kenya Medical Research Institute, University of Washington): Nelly Rwamba Mugo, Kenneth Ngure

Data Management was provided by DF/Net Research, Inc. (Seattle, WA). PrEP medication was donated by Gilead Sciences.

Funding

The Partners Demonstration Project was funded by the National Institute of Mental Health of the US National Institutes of Health (Grant R01 MH095507), the Bill & Melinda Gates Foundation (Grant OPP1056051), and through the US Agency for International Development (cooperative agreement AID-OAA-A-12-00023). Gilead Sciences donated the PrEP medication but had no role in data collection or analysis. The results and interpretation presented here do not necessarily reflect the views of the study funders.

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Authors and Affiliations

  1. Department of Global Health, University of Washington, Seattle, WA, USA

    Jennifer Velloza, Connie Celum, Jared M. Baeten & Renee Heffron

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Jennifer Velloza, Connie Celum, Jared M. Baeten & Renee Heffron

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Connie Celum & Jared M. Baeten

  4. Massachusetts General Hospital, Boston, MA, USA

    Jessica E. Haberer

  5. Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

    Kenneth Ngure

  6. Partners in Health and Research Development, Nairobi, Kenya

    Kenneth Ngure & Elizabeth Irungu

  7. Kenya Medical Research Institute, Nairobi, Kenya

    Nelly Mugo

  8. International Clinical Research Center, University of Washington, Box 359927, 325 Ninth Avenue, Seattle, WA, 98104, USA

    Renee Heffron

Authors
  1. Jennifer Velloza
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  2. Connie Celum
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  3. Jessica E. Haberer
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  4. Kenneth Ngure
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  5. Elizabeth Irungu
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  6. Nelly Mugo
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  7. Jared M. Baeten
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  8. Renee Heffron
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Consortia

Partners Demonstration Project Team

  • Jared Baeten
  • , Connie Celum
  • , Renee Heffron
  • , Deborah Donnell
  • , Ruanne Barnabas
  • , Jessica Haberer
  • , Harald Haugen
  • , Craig Hendrix
  • , Lara Kidoguchi
  • , Mark Marzinke
  • , Susan Morrison
  • , Jennifer Morton
  • , Norma Ware
  •  & Monique Wyatt

Corresponding author

Correspondence to Renee Heffron.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

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

Research Involving Human Participants and/or Animals

All procedures performed were in accordance with the ethical standards of the institutional review boards at the University of Washington and collaborating institutions in Kenya and Uganda, national research ethics committees for each study site, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Velloza, J., Celum, C., Haberer, J.E. et al. Depression and ART Initiation Among HIV Serodiscordant Couples in Kenya and Uganda. AIDS Behav 21, 2509–2518 (2017). https://doi.org/10.1007/s10461-017-1829-z

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