Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 8/2012

01-11-2012 | Substantive Review

Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review

Authors: Etheldreda Nakimuli-Mpungu, Judith K. Bass, Pierre Alexandre, Edward J. Mills, Seggane Musisi, Malathi Ram, Elly Katabira, Jean B. Nachega

Published in: AIDS and Behavior | Issue 8/2012

Login to get access

Abstract

This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5–38.2%, Tau2 = 0.23) and 18% (95% CI 12.3–25.8%, Tau2 = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31–0.66, Tau2 = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.
Literature
1.
2.
Jahn A, Floyd S, Crampin AC, et al. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet. 2008;371:1603–11.PubMedCrossRef
3.
Reniers G, Araya T, Davey G, et al. Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia. AIDS. 2009;23:511–8.PubMedCrossRef
4.
Parienti JJ, Das-Douglas M, Massari V, et al. Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS One. 2008;3:e2783.PubMedCrossRef
5.
Gill CJ, Hamer DH, Simon JL, Thea DM, Sabin LL. No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa. AIDS. 2005;19:1243–9.PubMedCrossRef
6.
Mills EJ, Nachega JB, Bangsberg, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3:e438.PubMedCrossRef
7.
Bangsberg DR. Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. J Infect Dis. 2008;197:S272–8.PubMedCrossRef
8.
Arrivillaga M, Ross M, Useche B, Alzate ML, Correa D. Social position, gender role, and treatment adherence among Colombian women living with HIV/AIDS: social determinants of health approach. Rev Panam Salud Publica. 2009;26:502–10.PubMedCrossRef
9.
Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18:S19–25.PubMedCrossRef
10.
Gibbie T, Hay M, Hutchison CW, Mijch A. Depression, social support and adherence to highly active antiretroviral therapy in people living with HIV/AIDS. Sex Health. 2007;4:227–32.PubMedCrossRef
11.
Gibbie T, Mijch A, Ellen S, et al. Depression and neuro-cognitive performance in individuals with HIV/AIDS: 2-year follow-up. HIV Med. 2006;7:112–21.PubMedCrossRef
12.
Aloisi MS, Arici C, Balzano R, et al. Behavioral correlates of adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31:S145–8.PubMedCrossRef
13.
Nachega JB, Trotta MP, Nelson M, Ammassari A. Impact of metabolic complications on antiretroviral treatment adherence: clinical and public health implications. Curr HIV/AIDS Rep. 2009;6:121–9.PubMedCrossRef
14.
Nachega JB, Leisegang R, Bishai D, et al. Association of antiretroviral therapy adherence and health care costs. Ann Intern Med. 2010;152:18–25.PubMed
15.
Veenstra N, Oyier A. The burden of HIV–related illness on outpatient health services in KwaZulu–natal, South Africa. AIDS Care. 2006;18:262–8.PubMedCrossRef
16.
Cruess DG, Evans DL, Repetto MJ, Gettes D, Douglas SD, Petitto JM. Prevalence, diagnosis, and pharmacological treatment of mood disorders in HIV disease. Biol Psychiatry. 2003;54:307–16.PubMedCrossRef
17.
Lazo M, Gange SJ, Wilson TE, et al. Patterns and predictors of changes in adherence to highly active antiretroviral therapy: longitudinal study of men and women. Clin Infect Dis. 2007;45:1377–85.PubMedCrossRef
18.
Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58:721–8.PubMedCrossRef
19.
Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV cost and services utilization study. J Stud Alcohol. 2002;63:179–86.PubMed
20.
Braithwaite RS, McGinnis KA, Conigliaro J, et al. A temporal and dose–response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29:1190–7.PubMedCrossRef
21.
Pence BW, Miller WC, Gaynes BN, Eron JJ Jr. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;44:159–66.PubMedCrossRef
22.
Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta–analysis. J Acquir Immune Defic Syndr. 2009;52:180–202.PubMedCrossRef
23.
24.
Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17:756–65.PubMedCrossRef
25.
Braithwaite RS, Conigliaro J, McGinnis KA, Maisto SA, Bryant K, Justice AC. Adjusting alcohol quantity for mean consumption and intoxication threshold improves prediction of non adherence in HIV patients and HIV-negative controls. Alcohol Clin Exp Res. 2008;32:1645–51.PubMedCrossRef
26.
Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20:1571–82.PubMedCrossRef
27.
Chander G, Himelhoch S, Moore RD. Substance abuse and psychiatric disorders in HIV positive patients: epidemiology and impact on antiretroviral therapy. Drugs. 2006;66:769–89.PubMedCrossRef
28.
Hunter JE, Schmidt FL. Methods of meta-analysis: correcting error and bias in research findings. 2nd ed. Thousand Oaks: Sage; 2004.
29.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef
30.
Rucker G, Schwarzer G, Carpenter JR, Schumacher M. Undue reliance on I (2) in assessing heterogeneity may mislead. BMC Med Res Methodol. 2008;8:79.PubMedCrossRef
31.
Duval SJ, Tweedie RL (2000) Trim and fill: a simple funnel plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:276–284CrossRef
32.
Comprehensive meta-analysis [computer program]. Version 2.0. Englewood: Biostat; 2009.
33.
Adewuya AO, Afolabi MO, Ola BA, et al. Relationship between depression and quality of life in persons with HIV infection in Nigeria. Int J Psychiatry Med. 2008;38:43–51.PubMedCrossRef
34.
Adewuya AO, Afolabi MO, Ola BA, et al. The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria. Psychosomatics. 2010;51:68–73.PubMed
35.
Amberbir A, Woldemichael K, Getachew S, Girma B, Deribe K. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in southwest Ethiopia. BMC Public Health. 2008;8:265.PubMedCrossRef
36.
Byakika-Tusiime J, Crane J, Oyugi JH, et al. Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-plus family treatment model: role of depression in declining adherence over time. AIDS Behav. 2009;13:S82–91.CrossRef
37.
Cohen MH, Fabri M, Cai X, et al. Prevalence and predictors of posttraumatic stress disorder and depression in HIV-infected and at-risk Rwandan women. J Womens Health. 2009;18:1783–91.CrossRef
38.
Do NT, Phiri K, Bussmann H, Gaolathe T, Marlink RG, Wester CW. Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana. AIDS Res Hum Retroviruses. 2010;26:685–91.PubMedCrossRef
39.
Etienne M, Hossain M, Redfield R, Stafford K, Amoroso A. Indicators of adherence to antiretroviral therapy treatment among HIV/AIDS patients in 5 African countries. J Int Assoc Physicians AIDS Care (Chic Ill). 2010;9:98–103.CrossRef
40.
Farley J, Miller E, Zamani A, et al. Screening for hazardous alcohol use and depressive symptomatology among HIV-infected patients in Nigeria: prevalence, predictors, and association with adherence. J Int Assoc Physicians AIDS Care (Chic). 2010;9:218–26.CrossRef
41.
Kagee A, Martin L. Symptoms of depression and anxiety among a sample of South African patients living with HIV. AIDS Care. 2010;22:159–65.PubMedCrossRef
42.
Kaharuza FM, Bunnell R, Moss S, et al. Depression and CD4 cell count among persons with HIV infection in Uganda. AIDS Behav. 2006;10:S105–11.PubMedCrossRef
43.
Kekwaletswe C, Morojele N, Nkosi S. Depression, alcohol use and adherence to antiretroviral therapy (ART). Poster presented at the 6th International AIDS Society Conference on HIV Pathogenesis and Treatment. Rome; 2011 [Abstract].
44.
Lawler K, Mosepele M, Seloilwe E, et al. Depression among HIV-positive individuals in Botswana: a behavioral surveillance. AIDS Behav. 2009;15:204–8.CrossRef
45.
Martinez P, Andia I, Emenyonu N, et al. Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in southwest Uganda. AIDS Behav. 2008;12:605–12.PubMedCrossRef
46.
Marwick KF, Kaaya SF. Prevalence of depression and anxiety disorders in HIV-positive out patients in rural Tanzania. AIDS Care. 2010;22:415–9.PubMedCrossRef
47.
Monahan PO, Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24:189–97.PubMedCrossRef
48.
Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22:147–58.PubMedCrossRef
49.
Nachega J, Morroni C, Ram M, Efron E, Chaisson R, Maartens G. Impact of concurrent TB treatment on ART adherence and liver toxicity in South African adults. 18th Conference on retroviruses and opportunistic infection, Boston; 2011 [Poster#883].
50.
Nakasujja N, Skolasky RL, Musisi S, et al. Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda. BMC Psychiatry. 2010;10:44.PubMedCrossRef
51.
Nakimuli-Mpungu E, Mutamba B, Othengo M, Musisi S. Psychological distress and adherence to highly active anti-retroviral therapy (HAART) in Uganda: a pilot study. Afr Health Sci. 2009;9:S2–7.PubMed
52.
Nakimuli–Mpungu E, Munyaneza G. Depression Alcohol abuse and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda. Neurobehav HIV Med. 2011;3:19–25.CrossRef
53.
Olley BO, Seedat S, Stein DJ. Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: a 6-month follow-up study. J Psychosom Res. 2006;61:479–84.PubMedCrossRef
54.
Patel R, Kassaye S, Gore-Felton C, et al. Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe. AIDS Care. 2009;21:1517–27.PubMedCrossRef
55.
Pearson CR, Micek MA, Pfeiffer J, et al. One year after ART initiation: psychosocial factors associated with stigma among HIV-positive Mozambicans. AIDS Behav. 2009;13:1189–96.PubMedCrossRef
56.
Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10:111.PubMedCrossRef
57.
Poupard M, Ngom Gueye NF, Thiam D, et al. Quality of life and depression among HIV-infected patients receiving efavirenz- or protease inhibitor-based therapy in Senegal. HIV Med. 2007;8:92–5.PubMedCrossRef
58.
Ramadhani HO, Thielman NM, Landman KZ, et al. Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania. Clin Infect Dis. 2007;45:1492–8.PubMedCrossRef
59.
Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape town, South Africa. Soc Sci Med. 2007;64:1823–31.PubMedCrossRef
60.
Spies G, Kader K, Kidd M, et al. Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. AIDS Care. 2009;21:1163–8.PubMedCrossRef
61.
Wagner G, Holloway I, Ghosh-Dastidar B, Kityo C, Mugyenyi P. Understanding the influence of depression on self-efficacy, work status, and condom use among HIV clients in Uganda. J Psychosom Res. 2010;70:440–8.PubMedCrossRef
62.
Weidle PJ, Wamai N, Solberg P, et al. Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda. Lancet. 2006;368:1587–94.PubMedCrossRef
63.
Tomlinson M, Grimsrud AT, Stein DJ, Williams DR, Myer L. The epidemiology of major depression in South Africa: results from the South African stress and health study. S Afr Med J. 2009;99:367–73.PubMed
64.
Ovuga E, Boardman J, Wasserman D. The prevalence of depression in two districts of Uganda. Soc Psychiatry Psychiatr Epidemiol. 2005;40:439–45.PubMedCrossRef
65.
Rothlind JC, Greenfield TM, Bruce AV, et al. Heavy alcohol consumption in individuals with HIV infection: effects on neuropsychological performance. J Int Neuropsychol Soc. 2005;11:70–83.PubMedCrossRef
66.
Murphy DA, Greenwell L, Hoffman D. Factors associated with antiretroviral adherence among HIV-infected women with children. Women Health. 2002;36:97–111.PubMedCrossRef
67.
Mbulaiteye SM, Ruberantwari A, Nakiyingi JS, Carpenter LM, Kamali A, Whitworth JA. Alcohol and HIV: a study among sexually active adults in rural southwest Uganda. Int J Epidemiol. 2000;29:911–5.PubMedCrossRef
68.
Shaffer DN, Njeri R, Justice AC, Odero WW, Tierney WM. Alcohol abuse among patients with and without HIV infection attending public clinics in western Kenya. East Afr Med J. 2004;81:594–8.PubMed
69.
Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8:141–51.PubMedCrossRef
70.
Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47:384–90.PubMedCrossRef
71.
Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2009;13:60–5.PubMedCrossRef
72.
Flaherty JA, Gaviria FM, Pathak D, et al. Developing instruments for cross-cultural psychiatric research. J Nerv Ment Dis. 1998;176:257–63.
73.
Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.PubMedCrossRef
74.
Bass JK, Bolton PA, Murray LK. Do not forget culture when studying mental health. Lancet. 2007;370:918–95.PubMedCrossRef
75.
WHO Brief Intervention Study Group. A cross-national trial of brief intervention with heavy drinkers. Am J Public Health. 1996;86:948–55.CrossRef
76.
Bass J, Neugebauer R, Clougherty KF, et al. Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: randomised controlled trial. Br J Psychiatry. 2006;188:567–73.PubMedCrossRef
Metadata
Title
Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review
Authors
Etheldreda Nakimuli-Mpungu
Judith K. Bass
Pierre Alexandre
Edward J. Mills
Seggane Musisi
Malathi Ram
Elly Katabira
Jean B. Nachega
Publication date
01-11-2012
Publisher
Springer US
Published in
AIDS and Behavior / Issue 8/2012
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-011-0087-8

Other articles of this Issue 8/2012

AIDS and Behavior 8/2012 Go to the issue

Original Paper

Relationship of Medication Management Test-Revised (MMT-R) Performance to Neuropsychological Functioning and Antiretroviral Adherence in Adults with HIV

Original Paper

Sexual Behavior as a Function of Stigma and Coping with Stigma Among People with HIV/AIDS in Rural New England

Brief Report

Bipolar Disorder is Associated with HIV Transmission Risk Behavior Among Patients in Treatment for HIV

Original Paper

Boredom, Depressive Symptoms, and HIV Risk Behaviors Among Urban Injection Drug Users

Original Paper

The Relationship Between Positive Psychological Attributes and Psychological Well-Being in Persons with HIV/AIDS

Original Paper

Predicting Depression in Mothers With and Without HIV: The Role of Social Support and Family Dynamics
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits