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Depressive Symptoms Before and After Antiretroviral Therapy Initiation Among Older-Aged Individuals in Rural Uganda

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Abstract

This study aims to characterize associations between depression symptom severity and HIV infection, both prior to and in years after ART initiation, among older adults. The Ugandan Non-Communicable Diseases & Aging Cohort Study (UGANDAC) is a study of 154 PLWH on ART and 142 community-based, HIV-negative controls. The Hopkins Checklist (HSCL), a 15-item depression scale, was used to screen for depression. We estimate differences in depressive symptoms by HIV and ART status and use multivariable log binomial regression to quantify differences in probable depression between PLWH on ART. HIV-infected and HIV-uninfected participants had a similar age (mean 52.0 vs. 51.9, p = 0.854) and sex distribution (47.4 vs. 47.9% female, p = 0.934). PLWH on ART had lower depression symptom severity than HIV-uninfected controls (mean score: 1.50 vs. 1.60, p = 0.006) and a lower prevalence of probable depression (21.4 vs. 33.8%, p = 0.017). Among 102 PLWH with pre-ART depression screening scores available, their mean depression symptom severity was similar to HIV-uninfected participants (mean 1.56 vs. 1.60, p = 0.512). In adjusted models, PLWH on ART had a lower prevalence of probable depression than HIV-negative controls [adjusted prevalence ratio: 0.68 (95% CI 0.47–0.99)]. In an observational cohort of PLWH over 40 on long-term ART and matched, community-based HIV-uninfected controls in rural Uganda, we found a lower prevalence of self-reported depression among aging PLWH on ART.

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Funding

This study was funded by the U.S. National Institutes of Health R21 HL124712, P30 AI060354, R24 AG044325, P30 AG024409, MGH Executive Committee on Research, and Friends of a Healthy Uganda. The authors acknowledge the following additional sources of support: K23 MH096620; K23 MH099916.

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Authors and Affiliations

  1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Jennifer Manne-Goehler

  2. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Jennifer Manne-Goehler & Till W. Bärnighausen

  3. Mbarara University of Science and Technology, Mbarara, Uganda

    Bernard Kakuhikire, Sheilah Abaasabyoona, Samson Okello, Alexander C. Tsai & Mark J. Siedner

  4. Institute of Public Health, University of Heidelberg, Heidelberg, Germany

    Till W. Bärnighausen

  5. Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

  6. Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, USA

    Alexander C. Tsai & Mark J. Siedner

  7. Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

    Mark J. Siedner

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  1. Jennifer Manne-Goehler
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Correspondence to Jennifer Manne-Goehler.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

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Manne-Goehler, J., Kakuhikire, B., Abaasabyoona, S. et al. Depressive Symptoms Before and After Antiretroviral Therapy Initiation Among Older-Aged Individuals in Rural Uganda. AIDS Behav 23, 564–571 (2019). https://doi.org/10.1007/s10461-018-2273-4

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