title: Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country.
abstract: BACKGROUND
  As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding the effect of psychosocial experiences and mental health symptomatology on ART adherence can help maximize the benefit of expanded ART programs by indicating types of services, which could be offered in combination with HIV care.
  
  
  METHODS
  The Coping with HIV/AIDS in Tanzania (CHAT) study is a longitudinal cohort study in the Kilimanjaro Region that included randomly selected HIV-infected (HIV+) participants from two local hospital-based HIV clinics and four free-standing voluntary HIV counselling and testing sites. Baseline data were collected in 2008 and 2009; this paper used data from 36 month follow-up interviews (N = 468). Regression analyses were used to predict factors associated with incomplete self-reported adherence to ART.
  
  
  RESULTS
  Incomplete art adherence was significantly more likely to be reported amongst participants who experienced a greater number of childhood traumatic events: sexual abuse prior to puberty and the death in childhood of an immediate family member not from suicide or homicide were significantly more likely in the non-adherent group and other negative childhood events trended toward being more likely. Those with incomplete adherence had higher depressive symptom severity and post-traumatic stress disorder (PTSD). In multivariable analyses, childhood trauma, depression, and financial sacrifice remained associated with incomplete adherence.
  
  
  CONCLUSIONS
  This is the first study to examine the effect of childhood trauma, depression and PTSD on HIV medication adherence in a low income country facing a significant burden of HIV. Allocating spending on HIV/AIDS toward integrating mental health services with HIV care is essential to the creation of systems that enhance medication adherence and maximize the potential of expanded antiretroviral access to improve health and reduce new infections.
authors.affiliation: Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America ; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.forename: Kristen
authors.initials: K
authors.lastname: Shirey
authors.forename: Brian Wells
authors.initials: BW
authors.lastname: Pence
authors.forename: Jia
authors.initials: J
authors.lastname: Yao
authors.forename: Nathan
authors.initials: N
authors.lastname: Thielman
authors.forename: Rachel
authors.initials: R
authors.lastname: Whetten
authors.forename: Julie
authors.initials: J
authors.lastname: Adams
authors.forename: Bernard
authors.initials: B
authors.lastname: Agala
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
authors.forename: Amy
authors.initials: A
authors.lastname: Hobbie
authors.forename: Venance
authors.initials: V
authors.lastname: Maro
authors.forename: Dafrosa
authors.initials: D
authors.lastname: Itemba
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reddy
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003863:Depression / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000150:complications; D013636:Tanzania
chemical_list: D019380:Anti-HIV Agents