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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence of Depressive Symptoms Amongst Highly Active Antiretroviral Therapy (HAART) Patients in AIDSRelief Uganda</title><author><name sortKey="Shumba, Constance" sort="Shumba, Constance" uniqKey="Shumba C" first="Constance" last="Shumba">Constance Shumba</name><affiliation><nlm:aff id="aff001"> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></nlm:aff></affiliation></author><author><name sortKey="Atukunda, Ruth" sort="Atukunda, Ruth" uniqKey="Atukunda R" first="Ruth" last="Atukunda">Ruth Atukunda</name><affiliation><nlm:aff id="aff001"> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></nlm:aff></affiliation></author><author><name sortKey="Imakit, Richard" sort="Imakit, Richard" uniqKey="Imakit R" first="Richard" last="Imakit">Richard Imakit</name><affiliation><nlm:aff id="aff001"> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></nlm:aff></affiliation></author><author><name sortKey="Memiah, Peter" sort="Memiah, Peter" uniqKey="Memiah P" first="Peter" last="Memiah">Peter Memiah</name><affiliation><nlm:aff id="aff002"><institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Baltimore, MD, USA</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28299108</idno><idno type="pmc">5345437</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345437</idno><idno type="RBID">PMC:5345437</idno><idno type="doi">10.4081/jphia.2013.e19</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002721</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002721</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence of Depressive Symptoms Amongst Highly Active Antiretroviral Therapy (HAART) Patients in AIDSRelief Uganda</title><author><name sortKey="Shumba, Constance" sort="Shumba, Constance" uniqKey="Shumba C" first="Constance" last="Shumba">Constance Shumba</name><affiliation><nlm:aff id="aff001"> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></nlm:aff></affiliation></author><author><name sortKey="Atukunda, Ruth" sort="Atukunda, Ruth" uniqKey="Atukunda R" first="Ruth" last="Atukunda">Ruth Atukunda</name><affiliation><nlm:aff id="aff001"> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></nlm:aff></affiliation></author><author><name sortKey="Imakit, Richard" sort="Imakit, Richard" uniqKey="Imakit R" first="Richard" last="Imakit">Richard Imakit</name><affiliation><nlm:aff id="aff001"> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></nlm:aff></affiliation></author><author><name sortKey="Memiah, Peter" sort="Memiah, Peter" uniqKey="Memiah P" first="Peter" last="Memiah">Peter Memiah</name><affiliation><nlm:aff id="aff002"><institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Baltimore, MD, USA</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Public Health in Africa</title><idno type="ISSN">2038-9922</idno><idno type="eISSN">2038-9930</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>There is limited data on the prevalence of depression in HIV and AIDS patients in Sub-Saharan Africa and little resources have been allocated to address this issue. Depression affects patient adherence to treatment and predisposes patients to resistance which poses a public health threat. It also affects quality of life and productivity of patients. From August 2008 to March 2009, 731 patient adherence surveys were administered to assess disease, treatment knowledge and services received. The primary variable of interest was patients’ level of depressive symptoms score, constructed using factor analysis from five survey questions relating to: sadness, need to be alone, hopelessness and confusion and was categorized as <italic>no depressive symptoms</italic> (score 0), <italic>low depressive symptoms</italic> (score 1-2), <italic>moderate depressive symptoms</italic> (score 3-4) and <italic>high depressive symptoms</italic> (score 5-10). Majority of the patients on highly active antiretroviral therapy (HAART) (59%) were found to have depressive symptoms and this was more among women than men (66% <italic>vs</italic> 43%). There was some association of depressive symptoms with non-disclosure (70% of those who had not disclosed had depressive symptoms compared to 53% among those who had disclosed). There is a high prevalence of depressive symptoms among adult patients on HAART. There is need for in-depth evaluation to find out the root causes of depressive symptoms among HAART patients in AIDSRelief clinics. There is need to integrate mental health management in HIV care and treatment as well as training the existing health workers on mental health management.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wagner, Gj" uniqKey="Wagner G">GJ Wagner</name></author><author><name sortKey="Holloway, I" uniqKey="Holloway I">I Holloway</name></author><author><name sortKey="Ghosh Dastidar, B" uniqKey="Ghosh Dastidar B">B Ghosh-Dastidar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, Dy" uniqKey="Wu D">DY Wu</name></author><author><name sortKey="Munoz, M" uniqKey="Munoz M">M Munoz</name></author><author><name sortKey="Espiritu, B" uniqKey="Espiritu B">B Espiritu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nakimuli Mpungu, E" uniqKey="Nakimuli Mpungu E">E Nakimuli-Mpungu</name></author><author><name sortKey="Musisi, S" uniqKey="Musisi S">S Musisi</name></author><author><name sortKey="Katabira, E" uniqKey="Katabira E">E Katabira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Penzak, Sr" uniqKey="Penzak S">SR Penzak</name></author><author><name sortKey="Reddy, Ys" uniqKey="Reddy Y">YS Reddy</name></author><author><name sortKey="Grimsley, Sr" uniqKey="Grimsley S">SR. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Public Health Africa</journal-id><journal-id journal-id-type="iso-abbrev">J Public Health Africa</journal-id><journal-id journal-id-type="publisher-id">JPHIA</journal-id><journal-title-group><journal-title>Journal of Public Health in Africa</journal-title></journal-title-group><issn pub-type="ppub">2038-9922</issn><issn pub-type="epub">2038-9930</issn><publisher><publisher-name>PAGEPress Publications, Pavia, Italy</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28299108</article-id><article-id pub-id-type="pmc">5345437</article-id><article-id pub-id-type="doi">10.4081/jphia.2013.e19</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Prevalence of Depressive Symptoms Amongst Highly Active Antiretroviral Therapy (HAART) Patients in AIDSRelief Uganda</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Shumba</surname><given-names>Constance</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Atukunda</surname><given-names>Ruth</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Imakit</surname><given-names>Richard</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Memiah</surname><given-names>Peter</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label> Uganda program,<institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Kampala Uganda</addr-line></aff><aff id="aff002"><label>2</label><institution>Institute of Human Virology, University of Maryland</institution>,<addr-line>Baltimore, MD, USA</addr-line></aff><author-notes><corresp id="cor1">Uganda Program, Institute of Human Virology, University of Maryland, 124 Luthuli Avenue, Bugolobi, Kampala, Uganda. Tel. <phone>+256774534599</phone>. E-mail: <email>konstansezw@googlemail.com</email></corresp><fn><p>Contributions: CS, RA, study coordination and manuscript drafting; PM, study conceiving and design, manuscript coordination and drafting; RI, statistical analysis. All authors read and approved the final manuscript.</p></fn><fn fn-type="COI-statement"><p>Conflict of interests: the authors declare no potential conflict of interests.</p></fn></author-notes><pub-date pub-type="epub"><day>26</day><month>11</month><year>2013</year></pub-date><pub-date pub-type="collection"><day>03</day><month>12</month><year>2013</year></pub-date><volume>4</volume><issue>2</issue><elocation-id>e19</elocation-id><history><date date-type="received"><day>03</day><month>2</month><year>2013</year></date><date date-type="rev-recd"><day>22</day><month>8</month><year>2013</year></date><date date-type="accepted"><day>11</day><month>11</month><year>2013</year></date></history><permissions><copyright-statement>©Copyright C. Shumba et al.</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Licensee PAGEPress, Italy</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>There is limited data on the prevalence of depression in HIV and AIDS patients in Sub-Saharan Africa and little resources have been allocated to address this issue. Depression affects patient adherence to treatment and predisposes patients to resistance which poses a public health threat. It also affects quality of life and productivity of patients. From August 2008 to March 2009, 731 patient adherence surveys were administered to assess disease, treatment knowledge and services received. The primary variable of interest was patients’ level of depressive symptoms score, constructed using factor analysis from five survey questions relating to: sadness, need to be alone, hopelessness and confusion and was categorized as <italic>no depressive symptoms</italic> (score 0), <italic>low depressive symptoms</italic> (score 1-2), <italic>moderate depressive symptoms</italic> (score 3-4) and <italic>high depressive symptoms</italic> (score 5-10). Majority of the patients on highly active antiretroviral therapy (HAART) (59%) were found to have depressive symptoms and this was more among women than men (66% <italic>vs</italic> 43%). There was some association of depressive symptoms with non-disclosure (70% of those who had not disclosed had depressive symptoms compared to 53% among those who had disclosed). There is a high prevalence of depressive symptoms among adult patients on HAART. There is need for in-depth evaluation to find out the root causes of depressive symptoms among HAART patients in AIDSRelief clinics. There is need to integrate mental health management in HIV care and treatment as well as training the existing health workers on mental health management.</p></abstract><kwd-group><title>Key words</title><kwd>depressive symptoms</kwd><kwd>highly active antiretroviral therapy (HAART)</kwd><kwd>people living with HIV (PLHIV)</kwd></kwd-group><counts><fig-count count="0"></fig-count><table-count count="1"></table-count><equation-count count="0"></equation-count><ref-count count="27"></ref-count><page-count count="4"></page-count></counts></article-meta></front><body><sec id="sec1-1"><title>Introduction</title><p>Depression is common among persons living with HIV/AIDS in Sub-Saharan Africa (SSA).<xref rid="ref1" ref-type="bibr"><sup>1</sup></xref> Prevalence of depression among people living with HIV (PLHIV) is between 21% and 63.3% in low income settings.<xref rid="ref2" ref-type="bibr"><sup>2-5</sup></xref> In studies done in the general population in SSA depression prevalence was found to be between 9-20%. In high income countries the prevalence of depression in PLHIV was found to be between 15-34%.<xref rid="ref6" ref-type="bibr"><sup>6</sup></xref> PLHIV have nearly twice the risk of developing depression and this affects their quality of life.<xref rid="ref7" ref-type="bibr"><sup>7</sup></xref> Moreover, whilst depression prevalence in PLHIV is higher than in the general population, the mental health of PLHIV is generally overlooked.<sup><xref rid="ref8" ref-type="bibr">8</xref>,<xref rid="ref9" ref-type="bibr">9</xref></sup> Although depression is treatable, only less than 50% of patients with depression are diagnosed and treated.<xref rid="ref10" ref-type="bibr"><sup>10</sup></xref> Low income countries face the challenge of channeling the few health resources towards mental health which is a low priority when compared with the burden and threat of infectious diseases.<sup><xref rid="ref11" ref-type="bibr">11</xref>,<xref rid="ref12" ref-type="bibr">12</xref></sup> The signs and symptoms of depression are similar in HIV-infected and non-infected patients, but patients with HIV infection may more frequently have sleep and appetite disturbances.<xref rid="ref4" ref-type="bibr"><sup>4</sup></xref> Depression may alter the course of HIV infection by impairing immune function or influencing behavior.<sup><xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref4" ref-type="bibr">4</xref></sup> It also has a negative effect on patients’ sexual risk behavior and substance abuse.<xref rid="ref10" ref-type="bibr"><sup>10</sup></xref> Depression is linked to poor self care practices among PLHIV and increased social isolation.<sup><xref rid="ref5" ref-type="bibr">5</xref>,<xref rid="ref8" ref-type="bibr">8</xref></sup></p><p>In PLHIV with chronic depression, CD4 cells decrease, viral load increases and they are also prone to a higher risk of clinical decline and mortality.<sup><xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref4" ref-type="bibr">4</xref>,<xref rid="ref8" ref-type="bibr">8</xref>,<xref rid="ref13" ref-type="bibr">13-15</xref></sup> In a study carried out in Uganda the prevalence of depression symptoms among PLHIV being initiated on antiretroviral therapy (ART) and followed up at 3 and 6 months was almost twice (53.9% <italic>vs</italic> 28%) that of HIV negative controls.<xref rid="ref16" ref-type="bibr"><sup>16</sup></xref></p><p>Although depression in the general population is highly prevalent in Uganda, it is rarely recognized as such.<xref rid="ref16" ref-type="bibr"><sup>16</sup></xref> Depression in PLHIV has been linked to low adherence to antiretroviral therapy.<sup><xref rid="ref2" ref-type="bibr">2-5</xref>,<xref rid="ref8" ref-type="bibr">8</xref>,<xref rid="ref12" ref-type="bibr">12</xref>,<xref rid="ref17" ref-type="bibr">17-22</xref></sup> This is because patients feel discouraged as a result of negative thoughts and hopelessness.<xref rid="ref7" ref-type="bibr"><sup>7</sup></xref> Lack of access to resources and gender inequalities have a strong bearing on depression in PLHIV particularly women.<sup><xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref4" ref-type="bibr">4</xref>,<xref rid="ref23" ref-type="bibr">23</xref></sup> Depression has also been linked to stigma.<sup><xref rid="ref10" ref-type="bibr">10</xref>,<xref rid="ref23" ref-type="bibr">23</xref></sup> In other studies low spiritual well-being and low perceived social support found to be a risk factor for depression in some groups of PLHIV.<xref rid="ref24" ref-type="bibr"><sup>24</sup></xref></p><p>In this paper we report the prevalence of depressive symptoms among PLHIV in AIDSRelief (AR) in order to use the evidence obtained to improve quality of care. This paper seeks to contribute to the knowledge of depressive symptoms prevalence among HIV patients on HAART using the AR experience in Uganda.</p></sec><sec sec-type="methods" id="sec1-2"><title>Materials and Methods</title><sec id="sec2-1"><title>Study setting and methods</title><p>In Uganda there are about 1.1 million PLHIV and 200,000 are on treatment.<xref rid="ref25" ref-type="bibr"><sup>25</sup></xref> AR Uganda program where this study was conducted has 79,989 PLHIV in care and 36,265 on HAART in 18 rural and under-served communities in the Northern, Southern, Central, Eastern and Western regions of Uganda. The program began in March 2004, working with faith-based and not-for-profit health facilities to strengthen their programming and technical capacities and applying evidence based data to improve care, treatment and community follow up.</p><p>As part of program evaluation the program adult patients 19 years and above on antiretro-viral treatment for 9-15 months were selected to participate in this study. The aim of this survey was to determine the prevalence of depressive symptoms among patients with HIV on HAART in AR clinics Uganda.</p></sec><sec id="sec2-2"><title>Data collection</title><p>Data was collected using the AIDSRelief adherence survey that has been piloted, validated and used in six African Countries. The survey was designed to identify specific indicators that influence adherence to antiretroviral therapy and increase in quality of life. This six component survey utilizing 46 questions was administered to the patient. Survey administrators were community health professionals trained using a unified source codebook. Components of the AR adherence survey included; family and support, assessing missed clinic appointments and/or doses, lifestyle and risk behaviors, belief in treatment, socioeconomics, support provided by clinic or hospital, depressive symptoms and mental health, assessing HIV and ART knowledge.</p><p>A sample of 732 adults was randomly selected for a patient adherence survey to assess disease, treatment knowledge and services received between August 2008 and March 2009. The number of participants selected for each site was proportional to the total number of eligible patients. Data was collected using an adherence survey questionnaire that included a depressive symptoms score. The primary variable of interest was patients’ level of depressive symptoms score, constructed using factor analysis from five survey questions relating to: sadness, need to be alone, hopelessness and confusion.</p><p>Depressive symptoms were measured from five questions related to mental health issues in the survey: i) In the past month, have you had persistent feelings of sadness or hopelessness that you just cannot control?; ii) How often do you feel the need to be alone?; iii) In the last month (or something better); have you lost interest in what used to give you pleasure?; iv) In the past month, how often have you felt confused or not yourself?; and v) How often do you feel that life is too difficult for you to go on? The responses for all these five questions were <italic>always</italic>, <italic>sometimes</italic>, <italic>never</italic>. The data coded responses of <italic>always</italic> as 2 <italic>sometimes</italic> 1 and <italic>never</italic> as 0. A summative score was created ranging from 0 and 10.</p></sec><sec id="sec2-3"><title>Statistical analysis</title><p>The total scores were then further categorized through the confirmatory factor analysis method (STATA version 11) into four categories; <italic>no depressive symptoms</italic>, <italic>low depressive symptoms</italic>, <italic>medium depressive symptoms</italic> and <italic>high depressive symptoms</italic>. The reliability of this scale in the study was at a Cronbach’s alpha of 0.87.</p><p>This survey was done as part of a routine quality improvement program. Adherence counselors and nurses at the AR clinics were trained to administer the questionnaire. Informed consent form was provided to the patients and after full explanation from the health staff about the survey, the patients would read through the consent and clarity provided. The patients appended his or her signature indicating consent to participate in the survey. Each patient had the right to withdraw at anytime in the course of the survey.</p></sec></sec><sec id="sec1-3"><title>Results</title><p>Of the 732 adults who participated in the survey, more than half (69%) were women. Most of the participants were aged between 19-50 years and majority had primary level education. About 90% of the participants who responded to the disclosure question had disclosed their HIV status.</p><p>Overall depressive symptoms prevalence was 59% and 26% experienced low depressive symptoms, 18% medium depressive symptoms and 14% high depressive symptoms. Women had a higher depressive symptoms score than men (66% <italic>vs</italic> 43%) and this was statistically significant at univariate analysis. Non-disclosure of HIV status showed some association with depressive symptom scores. Age and education level were not associated with depressive symptoms scores (<xref ref-type="table" rid="table001">Table 1</xref>).</p></sec><sec id="sec1-4"><title>Discussion</title><p>The study found a high (59%) prevalence of depressive symptoms amongst PLHIV in AR in Uganda. This is consistent with other studies which also found a prevalence of 57%.<sup><xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref4" ref-type="bibr">4</xref></sup> The survey was representative of the wider adult population experiences as it included both men and women unlike most studies on mental health of PLHIV which focus on subgroups thus lacking direct relevance to the wider population experiences.<xref rid="ref22" ref-type="bibr"><sup>22</sup></xref> This high level of depression maybe due to the fact that most AR patients are mostly rural, have a low socio-economic status and do not have access to resources.<xref rid="ref2" ref-type="bibr"><sup>2</sup></xref> Patients with many social and medical needs are more likely to have a diagnosis of depression.<xref rid="ref7" ref-type="bibr"><sup>7</sup></xref> Most of the PLHIV seen in AR clinics are women (69%) and this was consistent with another finding that women are a majority in HIV care and at the same time are more prone to depression.<xref rid="ref16" ref-type="bibr"><sup>16</sup></xref> This might also explain the high prevalence of depressive symptoms found in AR clinics of 58%.</p><p>Although depression is a serious debilitating illness in some parts of the world it is linked to western cultures and is believed to have low public health importance in some cultures due to the indirect link with mortality.<xref rid="ref11" ref-type="bibr"><sup>11</sup></xref> Depressive symptoms in Buganda are conceptualized as a problem related to thinking too much <italic>illness of thoughts</italic> resulting from various socioeconomic problems and requires no medication for thoughts.<xref rid="ref17" ref-type="bibr"><sup>17</sup></xref> This may also be true for AR patients who may not see this as a problem requiring medical intervention. Depression was found to be rarely diagnosed in HIV treatment settings in the US.<xref rid="ref5" ref-type="bibr"><sup>5</sup></xref> This is also true for AR where there is no routine screening for depressive symptoms.</p><p>Although some research on depression in PLHIV attributes it to lack of access to HAART and being on treatment for a short period of time.<xref rid="ref23" ref-type="bibr"><sup>23</sup></xref> The length of time itself was not defined, however we found that even though AR patients surveyed had been on HAART for 9-15 months, they still had a high prevalence of depressive symptoms. This suggests that depressive symptoms are transient and ongoing even after being on HAART for considerably long enough to start improving clinically and virologically.<xref rid="ref26" ref-type="bibr"><sup>26</sup></xref> However, Nakasujja <italic>et al.</italic> who reported that depressive symptoms improved with HAART initiation.<xref rid="ref16" ref-type="bibr"><sup>16</sup></xref> Their study found a decrease in depressive symptoms with increased functionality from HAART initiation up to 6 months of follow-up; 53.9% at HAART initiation, 36% at 3 months, and 30% at 6 months suggesting that access to HAART may improve depressive symptoms in the follow up phase. However, the study was very small with only 102 PLHIV study participants.</p><p>In another study carried out in Uganda there was 82.6% prevalence of psychiatric disorder among HIV patients including depression.<xref rid="ref27" ref-type="bibr"><sup>27</sup></xref> However, it was not clear whether the participants were on HAART and their duration on HAART. In addition the study had a very small sample size of forty-six. In another study when compared to non-depressed patients, those with sub-clinical depression had more likely been using ART for less than one year and had advanced HIV disease.<xref rid="ref3" ref-type="bibr"><sup>3</sup></xref> We did not make this comparison in our study.</p><p>In a study conducted in Uganda by Wilk and Bolton they found that some of the mental health consequences of HIV were self-hatred and self-pity.<xref rid="ref5" ref-type="bibr"><sup>5</sup></xref> It is suggested that individual coping mechanisms might have influence on how PLHIV experience depressive symptoms.<xref rid="ref5" ref-type="bibr"><sup>5</sup></xref> In one study it was found that patients were most likely to be virologically suppressed if they did not have a mental health diagnosis providing a strong argument for treating depressed PLHIV with HAART in view of improving outcomes.<xref rid="ref8" ref-type="bibr"><sup>8</sup></xref> However, in the AR PLO process all the patients had already been on HAART for 9-15 months. This suggests that whilst HAART may be effective in reducing depressive symptoms there remains a colossal need for treating depression as a co-morbid condition.<xref rid="ref8" ref-type="bibr"><sup>8</sup></xref></p><p>In areas with high HIV prevalence community led group interpersonal psychotherapy was found to reduce symptoms of depression and improve the quality of life of PLHIV.<sup><xref rid="ref7" ref-type="bibr">7</xref>,<xref rid="ref11" ref-type="bibr">11</xref></sup> This reinforces the importance of support groups.<xref rid="ref5" ref-type="bibr"><sup>5</sup></xref> There are culturally accepted ways of dealing with and healing depression and these have to be explored in every context and applied.<xref rid="ref17" ref-type="bibr"><sup>17</sup></xref> Targeted intervention could slow progression to AIDS.<xref rid="ref13" ref-type="bibr"><sup>13</sup></xref> There is need to identify barriers to seeking care for depressive symptoms among PLHIV. In most of the depression among PLHIV studies identified in review of literature most of the patients were not on HAART. Early recognition of risk factors and their redirection amongst PLHIV could reduce the emergence of depression. It is important to integrate mental health services in routine HIV care and encourage approaches that provide comprehensive care for PLHIV.</p><p>At the policy level there is need to develop an essential package of HIV care that includes mental health services whilst ensuring relevant and appropriate human resource capacity at the primary care level through training and task shifting. This also calls for sustained investments in mental health at the policy and implementation levels so as to ensure high quality care in scaling up HIV services using an integrated health systems approach. Building and relying on a robust evidence base is critical in developing targeted strategies for addressing mental health challenges among PLHIV. This also implies that it is necessary to engage PLHIV and their families in mental health programs.</p><p>More research needs to be done on the impact of HIV treatment on mental health. In addition, there may also be need to explore the meanings of depression in communities in Uganda. Further research must consider the qualitative and phenomenological perspectives of PLHIV and sub groups on depression as this may be useful in designing interventions. Qualitative in-depth studies need to be conducted on the characteristics of depression and the root causes in PLHIV on the AR program.</p><sec id="sec2-4"><title>Limitations</title><p>We did not explore the causes of the depressive symptoms in greater depth so cannot attribute the depressive symptoms to any particular factors. We also did not assess depressive symptoms prior to and at HAART initiation so cannot draw conclusions on whether HAART has an impact on depressive symptoms. The survey was carried out amongst AR patients who may have some unique characteristics and may not be generalized to all patients on HAART for the same period of time in elsewhere.</p></sec></sec><sec id="sec1-5"><title>Conclusions</title><p>Effective diagnosis and treatment of depression may be critical to maximizing the benefits of HIV treatment with regard to both HIV prevention and restoring the social and economic health of persons living with HIV. Linking HIV care to economic empowerment programs is necessary to reduce depression associated with lack of resources. Health workers including counselors need to be trained to recognize depressive symptoms and refer appropriately. 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pub-id-type="pmid">15319675</pub-id></mixed-citation></ref><ref id="ref27"><label>27.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Petrushkin</surname><given-names>H</given-names></name><name><surname>Boardman</surname><given-names>J</given-names></name><name><surname>Ovuga</surname><given-names>E.</given-names></name></person-group><article-title>Psychiatric disorders in HIV positive individuals in urban Uganda</article-title>. <source>Psychiatrist</source><year>2005</year>;<volume>29</volume>:<fpage>455</fpage>-<lpage>8</lpage>.</mixed-citation></ref></ref-list></back><floats-group><table-wrap id="table001" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Factors associated with depressive symptoms among patients on highly active antiretroviral therapy.</p></caption><table frame="box" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Total</th><th align="center" colspan="2" rowspan="1">Depression</th><th valign="top" align="center" rowspan="1" colspan="1">P-value</th></tr><tr><th align="left" valign="bottom" rowspan="1" colspan="1">Demographics</th><th align="center" valign="bottom" rowspan="1" colspan="1">N (%)</th><th align="center" rowspan="1" colspan="1">Yes<break></break>N (%)</th><th align="center" rowspan="1" colspan="1">No<break></break>N (%)</th><th align="center" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Gender</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">228 (31.15)</td><td align="center" rowspan="1" colspan="1">98 (42.98)</td><td align="center" rowspan="1" colspan="1">130(57.02)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">504 (68.85)</td><td align="center" rowspan="1" colspan="1">331(65.67)</td><td align="center" rowspan="1" colspan="1">173 (34.33)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Disclosure<xref ref-type="table-fn" rid="tfn001"><sup>*</sup></xref></td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.071</td></tr><tr><td align="left" rowspan="1" colspan="1"> Not disclosed</td><td align="center" rowspan="1" colspan="1">30 (10.35)</td><td align="center" rowspan="1" colspan="1">21(70.00)</td><td align="center" rowspan="1" colspan="1">9(30.00)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Disclosed</td><td align="center" rowspan="1" colspan="1">260 (89.65)</td><td align="center" rowspan="1" colspan="1">137(52.69)</td><td align="center" rowspan="1" colspan="1">123 (47.31)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Age group<xref ref-type="table-fn" rid="tfn001"><sup>*</sup></xref></td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 19-39</td><td align="center" rowspan="1" colspan="1">294 (43.55)</td><td align="center" rowspan="1" colspan="1">183(62.24)</td><td align="center" rowspan="1" colspan="1">112(37.76)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> 40-50</td><td align="center" rowspan="1" colspan="1">290 (42.96)</td><td align="center" rowspan="1" colspan="1">168(57.93)</td><td align="center" rowspan="1" colspan="1">122(42.07)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> 50+</td><td align="center" rowspan="1" colspan="1">91 (13.48)</td><td align="center" rowspan="1" colspan="1">49(53.85)</td><td align="center" rowspan="1" colspan="1">42(46.15)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Education level<xref ref-type="table-fn" rid="tfn001"><sup>*</sup></xref></td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.138</td></tr><tr><td align="left" rowspan="1" colspan="1"> Primary</td><td align="center" rowspan="1" colspan="1">363 (53.70)</td><td align="center" rowspan="1" colspan="1">218(60.06)</td><td align="center" rowspan="1" colspan="1">145(39.94)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Secondary</td><td align="center" rowspan="1" colspan="1">261(38.61)</td><td align="center" rowspan="1" colspan="1">158(60.54)</td><td align="center" rowspan="1" colspan="1">103(39.46)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> University</td><td align="center" rowspan="1" colspan="1">52 (7.69)</td><td align="center" rowspan="1" colspan="1">24(46.15)</td><td align="center" rowspan="1" colspan="1">28(53.85)</td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn id="tfn001"><p><sup>*</sup>The totals do not add up to 732 because of missing data.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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