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Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa

BACKGROUND: Depression is a leading cause of disability and may be associated with decreased adherence to ART. We sought to describe the prevalence of depressive symptoms and outcomes one year after screening among patients receiving ART at a large HIV Clinic in Johannesburg, South Africa. METHODS:...

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Autores principales: Shearer, Kate, Evans, Denise, Xhosa, Barbara, Hirasen, Kamban, Bracken, Craig, Mahomed, Kay, Long, Lawrence, Fox, Matthew P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155448/
https://www.ncbi.nlm.nih.gov/pubmed/30252844
http://dx.doi.org/10.1371/journal.pone.0203797
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author Shearer, Kate
Evans, Denise
Xhosa, Barbara
Hirasen, Kamban
Bracken, Craig
Mahomed, Kay
Long, Lawrence
Fox, Matthew P.
author_facet Shearer, Kate
Evans, Denise
Xhosa, Barbara
Hirasen, Kamban
Bracken, Craig
Mahomed, Kay
Long, Lawrence
Fox, Matthew P.
author_sort Shearer, Kate
collection PubMed
description BACKGROUND: Depression is a leading cause of disability and may be associated with decreased adherence to ART. We sought to describe the prevalence of depressive symptoms and outcomes one year after screening among patients receiving ART at a large HIV Clinic in Johannesburg, South Africa. METHODS: Adult (≥18) patients who had been on first-line ART between 6–18 months who could communicate in English were eligible. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9 and a score ≥10 indicated depression. RESULTS: 97 patients enrolled. Patients had been on ART for a median (IQR) of 8 (7–10) months, 61% were female, the median (IQR) age at enrollment was 38 (33–42) years, and the median (IQR) CD4 count at ART initiation was 154.5 (65–263) cells/mm(3). 7 (7%) patients were found to have symptoms of depression; 4 (4%) had symptoms of moderate depression (PHQ score of 10–14) and 3 (3%) had symptoms of moderate/severe depression (PHQ score of 15–19). Women (10%) were more likely to have symptoms of depression than men (3%; prevalence difference [PD]: 7.5%; 95% confidence interval [CI]:-1.7%-16.8%); as were patients under the age of 30 (14%) compared to those 30–39 (4%; PD: -10.2; 95% CI: -29.4–9.0%) or ≥40 (9%; PD: -5.5%; -26.1%-15.2%), those with lower CD4 counts at ART initiation (<200 cells/mm(3) vs ≥200 cells/mm(3): 8% vs 3%; PD: 4.8%; 95% CI: -4.5%-14.0%), and those with high viral loads (>1000 copies/mL vs. <400 copies/mL: 40% vs. 5%; PD: 34.6%; 95% CI: -8.6%-77.6%). No relationship between depressive symptoms and retention in HIV care one year after screening was observed. CONCLUSIONS: We found a lower prevalence of depressive symptoms compared to findings from other HIV-positive populations in South Africa but more than one-third of patients with an elevated viral load had evidence of depression. Further research on the relationship between depression, adherence, and viral failure is warranted as this may present an opportunity for early interventions to improve treatment outcomes and reduce the need for second-line treatment.
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spelling pubmed-61554482018-10-19 Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa Shearer, Kate Evans, Denise Xhosa, Barbara Hirasen, Kamban Bracken, Craig Mahomed, Kay Long, Lawrence Fox, Matthew P. PLoS One Research Article BACKGROUND: Depression is a leading cause of disability and may be associated with decreased adherence to ART. We sought to describe the prevalence of depressive symptoms and outcomes one year after screening among patients receiving ART at a large HIV Clinic in Johannesburg, South Africa. METHODS: Adult (≥18) patients who had been on first-line ART between 6–18 months who could communicate in English were eligible. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9 and a score ≥10 indicated depression. RESULTS: 97 patients enrolled. Patients had been on ART for a median (IQR) of 8 (7–10) months, 61% were female, the median (IQR) age at enrollment was 38 (33–42) years, and the median (IQR) CD4 count at ART initiation was 154.5 (65–263) cells/mm(3). 7 (7%) patients were found to have symptoms of depression; 4 (4%) had symptoms of moderate depression (PHQ score of 10–14) and 3 (3%) had symptoms of moderate/severe depression (PHQ score of 15–19). Women (10%) were more likely to have symptoms of depression than men (3%; prevalence difference [PD]: 7.5%; 95% confidence interval [CI]:-1.7%-16.8%); as were patients under the age of 30 (14%) compared to those 30–39 (4%; PD: -10.2; 95% CI: -29.4–9.0%) or ≥40 (9%; PD: -5.5%; -26.1%-15.2%), those with lower CD4 counts at ART initiation (<200 cells/mm(3) vs ≥200 cells/mm(3): 8% vs 3%; PD: 4.8%; 95% CI: -4.5%-14.0%), and those with high viral loads (>1000 copies/mL vs. <400 copies/mL: 40% vs. 5%; PD: 34.6%; 95% CI: -8.6%-77.6%). No relationship between depressive symptoms and retention in HIV care one year after screening was observed. CONCLUSIONS: We found a lower prevalence of depressive symptoms compared to findings from other HIV-positive populations in South Africa but more than one-third of patients with an elevated viral load had evidence of depression. Further research on the relationship between depression, adherence, and viral failure is warranted as this may present an opportunity for early interventions to improve treatment outcomes and reduce the need for second-line treatment. Public Library of Science 2018-09-25 /pmc/articles/PMC6155448/ /pubmed/30252844 http://dx.doi.org/10.1371/journal.pone.0203797 Text en © 2018 Shearer et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shearer, Kate
Evans, Denise
Xhosa, Barbara
Hirasen, Kamban
Bracken, Craig
Mahomed, Kay
Long, Lawrence
Fox, Matthew P.
Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
title Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
title_full Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
title_fullStr Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
title_full_unstemmed Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
title_short Low prevalence of depressive symptoms among stable patients on antiretroviral therapy in Johannesburg, South Africa
title_sort low prevalence of depressive symptoms among stable patients on antiretroviral therapy in johannesburg, south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155448/
https://www.ncbi.nlm.nih.gov/pubmed/30252844
http://dx.doi.org/10.1371/journal.pone.0203797
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