Depression and patterns of self-reported adherence to antiretroviral therapy in Rwanda.
We determined the prevalence of depression in HIV-infected adults on antiretroviral therapy in rural Rwanda and measured the association of depression with non-adherence. In all, 292 patients on antiretroviral therapy for ≥6 months were included. Adherence was self-reported by four-day recall, two- and seven-day treatment interruptions, and the CASE Index, which is a composite score accounting for difficulty taking medications on time, the average number of days per week a dose is missed, and the most recent missed dose. A total of 84% and 87% of participants reported good adherence by the four-day recall and CASE Index, respectively; 13% of participants reported two-day treatment interruptions; and 11% were depressed. Depression was significantly associated with two-day treatment interruptions but not with other measures of non-adherence. Self-reported adherence to antiretroviral therapy in rural Rwanda is high. Adherence assessments that do not consider treatment interruptions may miss important patterns of non-adherence, which may be especially prevalent among depressed individuals. Mental health interventions incorporated into routine HIV care may lead to improvements in mental health and adherence.
Department of Internal Medicine, Brigham & Women's Hospital, Boston, MA, USA Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda ewroe@partners.org.
Emily B
EB
Wroe
Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA University of Rwanda College of Medicine and Health Sciences, Butare, Rwanda.
Bethany L
BL
Hedt-Gauthier
Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Molly F
MF
Franke
Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda.
Sabin
S
Nsanzimana
Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
Jean Bosco
JB
Turinimana
Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA.
Peter
P
Drobac
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology*; D015995:Prevalence; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology; D057566:Self Report; D055815:Young Adult
D019380:Anti-HIV Agents
AIDS; Africa; HIV; adherence; antiretroviral therapy; depression; screening; treatment; viral disease