title: Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study.
abstract: BACKGROUND
  While studies have suggested that depression and HIV-related stigma may impede access to care, a growing body of literature also suggests that access to HIV care itself may help to decrease internalized HIV-related stigma and symptoms of depression in the general population of persons living with HIV. However, this has not been investigated in postpartum women living with HIV. Furthermore, linkage to care itself may have additional impacts on postpartum depression beyond the effects of antiretroviral therapy. We examined associations between linkage to HIV care, postpartum depression, and internalized stigma in a population with a high risk of depression: newly diagnosed HIV-positive pregnant women.
  
  
  METHODS
  In this prospective observational study, data were obtained from 135 HIV-positive women from eight antenatal clinics in the rural Nyanza Province of Kenya at their first antenatal visit (prior to testing HIV-positive for the first time) and subsequently at 6 weeks after giving birth.
  
  
  RESULTS
  At 6 weeks postpartum, women who had not linked to HIV care after testing positive at their first antenatal visit had higher levels of depression and internalized stigma, compared to women who had linked to care. Internalized stigma mediated the effect of linkage to care on depression. Furthermore, participants who had both linked to HIV care and initiated antiretroviral therapy reported the lowest levels of depressive symptoms.
  
  
  CONCLUSIONS
  These results provide further support for current efforts to ensure that women who are newly diagnosed with HIV during pregnancy become linked to HIV care as early as possible, with important benefits for both physical and mental health.
authors.affiliation: Department of Psychology, University of Alabama at Birmingham, CH 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA. bturanb@gmail.com.
authors.forename: Bulent
authors.initials: B
authors.lastname: Turan
authors.affiliation: Department of Sociology, University of Alabama at Birmingham, HHB 460, 1720 2nd Ave South, Birmingham, AL, 35294-1152, USA. Kls5n@uab.edu.
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Stringer
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. maricianah@yahoo.com.
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. ebukusi@rctp.or.ke.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. Sheri.Weiser@ucsf.edu.
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. CCohen@globalhealth.ucsf.edu.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. jmturan@uab.edu.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D019052:Depression, Postpartum / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care; D011446:Prospective Studies; D012424:Rural Population; D057545:Social Stigma; D055815:Young Adult