HIV / STI
The effect of depressive symptoms on six month antiretroviral therapy adherence among women with HIV of reproductive age Karen Diepstra* Karen Diepstra Andrew Edmonds Paul N. Zivich Catalina Ramirez Maria L. Alcaide Deborah L. Jones Seble Kassaye Deborah Konkle-Parker Anandi N. Sheth Elizabeth F. Topper Aadia Rana Daniel J. Westreich
Background: Depression can negatively impact antiretroviral therapy (ART) adherence. We examined the effect of depressive symptoms on ART adherence among women with HIV (WWH) of reproductive age in the Southern US.
Methods: Using the Study of Treatment and Reproductive Outcomes cohort data, we identified WWH receiving ART at enrollment. Self-report of baseline depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CESD) scale. The outcome was self-reported ART adherence (100% adherence vs. <100% adherence) at the 6-month visit. Using g-computation, we estimated the dose-response effect of CESD. We also compared the probability of 100% adherence given the observed CESD scores in the sample vs. the probability under two hypothetical depression interventions (e.g., cognitive behavior therapy) which reduced CESD scores in all participants by 3 and 6 points.
Results: Of 513 WWH receiving ART, we identified 480 with complete baseline data, of whom 311 (61%) had outcome data at the 6-month visit. The median CESD score was 11 (interquartile range: 5-21); 184 (38%) had a CESD score >16 – a cutoff traditionally used to detect clinical depression. Among those with a 6-month visit, 172 (55%) reported 100% ART adherence. Compared to CESD=0, the probability of 100% ART adherence was 0.8 points higher for CESD=16 (95% CI: -18.7, 20.2) and 5.9 points lower for CESD=23 (95% CI: -23.7, 11.9) (Figure). The interventions to reduce CESD score by 3 or 6 points increased the probability of 100% ART adherence by 0.9 (95% CI: -1.2, 3.0) and 1.4 (95% CI: -1.7, 4.5) percentage points, respectively.
Conclusions: We found high depressive symptom prevalence among WWH of reproductive age in the Southern US. Above the threshold of 16, higher CESD scores (compared to CESD=0) were associated with lower probability of 100% ART adherence, though 95% CIs were wide. Depression interventions for individuals with clinical symptoms may have an impact on HIV-related care in this population.
