Lifetime Depressive Disorders and Adherence to Anti-retroviral Therapy in HIV-infected Ugandan Adults: a Case-control Study

Background: There is limited information on the impact of lifetime depressive disorders on adherence to ART.

Aim: We examined the association between lifetime depressive disorders and adherence to anti-retroviral therapy (ART) among a rural clinic-based HIV positive population. We further explored whether this association was mediated by current depression and moderated by gender.

Methods: Two hundred HIV positive individuals who had<95% adherence and two hundred HIV positive individuals who had ≥95% adherence were screened for depression using the self-reporting questionnaire (SRQ-20) and evaluated with the Mini neuropsychiatric interview (MINI). Multivariate logistic regression was used to assess the association between lifetime depressive disorders and adherence to ART. The logistic regression model of Baron and Kenny was used to evaluate the mediating effect of current depression. Hierarchical binomial logistic regression was used to evaluate the moderating effect of gender.

Results: HIV positive individuals with lifetime depressive disorders had an increased risk of non-adherence to ART after controlling for education status, income, self-efficacy, perceived social support, cognitive impairment and current alcohol use disorders [AOR=1.68, 95%CI (1.02-2.79), p=0.04]. This association was stronger in females than males [AOR= 4.76, 95%CI (1.52-14.97), p=0.008].

Limitations: Findings cannot be generalized to ART naïve individuals or those using ART for less than six months.

Conclusion: Lifetime depressive disorders are associated with increased risk of non-adherence to ART in rural women with HIV infection in southern Uganda. Detection and treatment of depression can potentially improve adherence with HIV treatment in this setting.