title: Effects of Depression Alleviation on ART Adherence and HIV Clinic Attendance in Uganda, and the Mediating Roles of Self-Efficacy and Motivation.
abstract: With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors.
authors.affiliation: RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA. gwagner@rand.org.
authors.forename: Glenn J
authors.identifier: http://orcid.org/0000-0001-9081-3299
authors.initials: GJ
authors.lastname: Wagner
authors.affiliation: RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ghosh-Dastidar
authors.affiliation: RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Robinson
authors.affiliation: RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Ngo
authors.affiliation: RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Glick
authors.affiliation: Mildmay Uganda, Kampala, Uganda.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mukasa
authors.affiliation: Department of Psychiatry, Makerere University, Kampala, Uganda.
authors.forename: Seggane
authors.initials: S
authors.lastname: Musisi
authors.affiliation: Department of Psychiatry, Makerere University, Kampala, Uganda.
authors.forename: Dickens
authors.initials: D
authors.lastname: Akena
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003376:Counseling; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009042:Motivation; D009819:Office Visits / Q000706:statistics & numerical data*; D020377:Self Efficacy; D057566:Self Report; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Clinic attendance; Depression; HIV; Motivation; Self-efficacy; Uganda