Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV.
Psychological distress is common among adolescents living with HIV (ALHIV) worldwide, and has been associated with non-adherence to anti-retroviral therapy (ART), leading to poor virologic suppression, drug resistance, and increased risk for AIDS morbidity and mortality. However, only a few studies have explored the relationship between psychological distress and ART adherence among adolescents in sub-Saharan Africa. The paper examines the relationship between psychological distress and ART adherence, and effect of psychosocial resources on ART adherence. We conducted a cross-sectional survey of 464 ALHIV (aged 12-19; 53% female) seeking HIV care at a large HIV treatment center in Kampala, Uganda. ALHIV were recruited during routine clinic visits. Three self-reported binary adherence measures were utilized: missed pills in the past three days, non-adherence to the prescribed medical regimen, and self-rated adherence assessed using a visual analog scale. Psychological distress was measured as a continuous variable, and computed as the mean score on a locally developed and validated 25-item symptom checklist for Ugandan ALHIV. Psychosocial resources included spirituality, religiosity, optimism, social support, and coping strategies. After adjusting for respondents' socio-demographic characteristics and psychosocial resources, a unit increase in psychological distress was associated with increased odds of missing pills in past 3 days (Odds Ratio(OR) = 1.75; Confidence Interval (CI): 1.04-2.95), not following the prescribed regimen (OR = 1.63; CI: 1.08-2.46), and lower self-rated adherence (OR = 1.79; CI: 1.19-2.69). Psychosocial resources were associated with lower odds for non-adherence on all three self-report measures. There is a need to strengthen the psychosocial aspects of adolescent HIV care by developing interventions to identify and prevent psychological distress among Ugandan ALHIV.
a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA.|b Joint Clinical Research Center , Kampala , Uganda.
Massy
M
Mutumba
b Joint Clinical Research Center , Kampala , Uganda.|c Department of Pediatrics , Makerere University College of Health Sciences , Kampala , Uganda.
Victor
V
Musiime
d Survey Methodology Program , University of Michigan , Ann Arbor , MI , USA.
James M
JM
Lepkwoski
a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA.
Gary W
GW
Harper
a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA.
Rachel C
RC
Snow
a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA.
Ken
K
Resnicow
a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA.
Jose A
JA
Bauermeister
D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D020380:Needs Assessment; D016017:Odds Ratio; D057566:Self Report; D012944:Social Support; D013315:Stress, Psychological / Q000503:physiopathology / Q000517:prevention & control; D014454:Uganda / Q000453:epidemiology
D044966:Anti-Retroviral Agents
Africa; HIV care; Youth; coping; mental health