title: Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review.
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%, Tau(2) = 0.23) and 18% (95% CI 12.3-25.8%, Tau(2) = 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, Tau(2) = 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.
authors: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Hampton House, Baltimore, MD, 21205, USA. enakimul@jhsph.edu
authors: Etheldreda
authors: E
authors: Nakimuli-Mpungu
authors: Judith K
authors: JK
authors: Bass
authors: Pierre
authors: P
authors: Alexandre
authors: Edward J
authors: EJ
authors: Mills
authors: Seggane
authors: S
authors: Musisi
authors: Malathi
authors: M
authors: Ram
authors: Elly
authors: E
authors: Katabira
authors: Jean B
authors: JB
authors: Nachega
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000523:psychology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology / Q000706:statistics & numerical data; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents