Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda.
In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda.



A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (n = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence.



Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55-5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01-1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms.



The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; mary_smith-fawzi@hms.harvard.edu.
Mary C
MC
Smith Fawzi
Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Lauren
L
Ng
Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda.
Fredrick
F
Kanyanganzi
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Catherine
C
Kirk
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Justin
J
Bizimana
Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda.
Felix
F
Cyamatare
Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda.
Christina
C
Mushashi
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
Taehoon
T
Kim
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Yvonne
Y
Kayiteshonga
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.|Dartmouth College, Hanover, New Hampshire; and.|University of Global Health Equity, Kigali, Rwanda.
Agnes
A
Binagwaho
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Theresa S
TS
Betancourt
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology
D019380:Anti-HIV Agents
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