Ekat Martin Herbas, Yotebieng Marcel, Leroy Valériane, Mpody Christian, Diafouka Merlin, Loubaki Gilbert, Nsondé Dominique Mahambou-, Ossibi Ibara Bienvenu Rolland, Bernard Charlotte, Sabin Caroline, Becquet Renaud
Unit of Infectious Diseases, Brazzaville University Hospital, Brazzaville, Congo.
Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Medicine (Baltimore). 2020 Aug 28;99(35):e21606. doi: 10.1097/MD.0000000000021606.
The increasing availability of antiretroviral therapy (ART) worldwide is yet to result in decreasing HIV-related mortality among adolescents (10-19 years old) living with HIV (ALHIV) in part because of poor adherence. the poor adherence might itself be due to high level of depression. We assess the prevalence of depressive symptomatology and it's associated with adherence among ALHIV receiving ART care in Brazzaville and Pointe Noire, Republic of Congo (RoC).Adolescents aged 10 to 19 years, on antiretroviral therapy (ART), followed in the two Ambulatory Treatment Centers (ATC) in Brazzaville and Pointe Noire, RoC were included in this cross-sectional study. From April 19 to July 9, 2018, participants were administered face to face interviews using a standardized questionnaire that included the nine-item Patient Health Questionnaire (PHQ-9). Participants who reported failing to take their ART more than twice in the 7 days preceding the interview were classified as non-adherent. Bivariate and multivariable log-binomial models were used to estimate the prevalence ratio (PR) and 95% confidence interval (95%CI) assessing the strength of association between predictors and presence of depressive symptoms (PHQ-9 score ≥9).Overall, 135 adolescents represented 50% of ALHIV in active care at the 2 clinics were interviewed. Of those, 67 (50%) were male, 81 (60%) were 15 to 19 years old, 124 (95%) had been perinatally infected, and 71 (53%) knew their HIV status. Depressive symptoms were present in 52 (39%) participants and 78 (58%) were adherent. In univariate analyses, the prevalence of depressive symptoms was relative higher among participants who were not adherent compared to those who were (73% vs 33%; PR: 2.20 [95%CI: 1.42-3.41]). In multivariate analysis, after adjustment for report of been sexually active, alcohol drinking, age category (10-14 and 15-19), not in school, loss of both parents, the association between depression and adherence was strengthened (PR: 2.06 [95%CI: 1.23-3.45]).The prevalence of depressive symptoms in adolescents living with HIV is high and was strongly associated with poor adherence even after adjustment of potential confounders. Efforts to scale-up access to screening and management of depression among ALHIV in sub-Saharan is needed for them to realize the full of ART.
抗逆转录病毒疗法（ART）在全球范围内的可及性日益提高，但这尚未导致10至19岁感染艾滋病毒青少年（ALHIV）中与艾滋病毒相关的死亡率下降，部分原因是依从性差。依从性差本身可能是由于抑郁症水平高。我们评估了刚果共和国布拉柴维尔和黑角接受ART治疗的ALHIV中抑郁症状的患病率及其与依从性的关联。10至19岁接受抗逆转录病毒疗法（ART）治疗并在刚果共和国布拉柴维尔和黑角的两个门诊治疗中心（ATC）接受随访的青少年被纳入这项横断面研究。2018年4月19日至7月9日，使用包括九项患者健康问卷（PHQ-9）的标准化问卷对参与者进行面对面访谈。报告在访谈前7天内未服用ART超过两次的参与者被归类为不依从。使用双变量和多变量对数二项式模型来估计患病率比（PR）和95%置信区间（95%CI），以评估预测因素与抑郁症状（PHQ-9评分≥9）存在之间的关联强度。总体而言，135名青少年代表了这两家诊所接受积极治疗的ALHIV的50%，并接受了访谈。其中，67名（50%）为男性，81名（60%）年龄在15至19岁之间，124名（95%）为围产期感染，71名（53%）知道自己的艾滋病毒感染状况。52名（39%）参与者存在抑郁症状，78名（58%）依从。在单变量分析中，与依从的参与者相比，不依从的参与者中抑郁症状的患病率相对较高（73%对33%；PR：2.20[95%CI：1.42-3.41]）。在多变量分析中，在对性活跃报告、饮酒、年龄类别（10至14岁和15至19岁）、未上学、父母双亡进行调整后，抑郁与依从性之间的关联得到加强（PR：2.06[95%CI：1.23-3.45]）。感染艾滋病毒青少年中抑郁症状的患病率很高，即使在调整潜在混杂因素后，也与依从性差密切相关。撒哈拉以南非洲地区需要努力扩大对ALHIV中抑郁症筛查和管理的可及性，以使他们充分受益于ART。
