Population Council, Washington, DC, United State of America.
Independent consultant, Barcelona, Spain.
PLoS One. 2021 Mar 5;16(3):e0247974. doi: 10.1371/journal.pone.0247974. eCollection 2021.
Few studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect ART adherence among caregivers who report testing positive for HIV and currently on ART.
We interviewed 818 adult caregivers of children aged 0-17 years living in vulnerable households in 24 health facility catchment areas in five districts in rural southern Malawi in 2016-2017. Vulnerable households had either economic and food insecurity, or chronic illness. Questions on five depressive symptoms were used. ART adherence was self-report of not forgetting to take ART medication in the last week. Perceived and anticipated measures of stigma were used. Multivariable linear and logistic regressions documented relationships between depressive symptoms, self-reported HIV status, HIV-related stigma, and ART adherence.
Most caregivers were women (86.2%); about one third had no spouse or live-in partner. Fifty-seven percent of caregivers reported having three or more depressive symptoms. Forty-one percent of caregivers reported testing positive for HIV. Self-reported HIV positive status was associated with depressive symptoms (adjusted coeff = 0.355, p-value <0.001), which were in turn associated with poorer ART adherence among caregivers (aOR 0.639, p-value = 0.023). HIV-related stigma was also associated with depressive symptoms for caregivers who reported having HIV (coeff = 0.302, p-value = 0.028) and those who reported testing negative for HIV (coeff = 0.187, p-value <0.001). Having social support was associated with lower depressive symptoms (coeff = -0.115, p = 0.007). HIV-related stigma, having social support, and other socio-demographic characteristics were not found to be associated with ART adherence.
Addressing mental health among caregivers in vulnerable households may be an important step toward achieving viral suppression among vulnerable populations living with HIV in Malawi. Integrating depression screening into HIV care and treatment protocols could be a promising intervention to improve longer-term outcomes.
鲜有研究探讨易受感染人群中抑郁症状、HIV 感染和污名之间的关联。本研究旨在检验马拉维脆弱家庭中照顾者出现抑郁症状的相关因素，并评估报告出现 HIV 阳性和正在接受抗逆转录病毒治疗（ART）的照顾者中，出现的抑郁症状和其他因素如何影响他们对 ART 的坚持。
我们于 2016-2017 年在马拉维农村南部五个地区的 24 个卫生机构服务范围内，对 818 名 0-17 岁儿童的成年照顾者进行了访谈。脆弱家庭要么经济和粮食不安全，要么患有慢性疾病。使用了五个抑郁症状问题。ART 坚持是指自我报告在过去一周内没有忘记服用 ART 药物。使用感知和预期的污名措施。多变量线性和逻辑回归记录了抑郁症状、自我报告的 HIV 状况、HIV 相关污名和 ART 坚持之间的关系。
大多数照顾者为女性（86.2%）；约三分之一的人没有配偶或同居伴侣。57%的照顾者报告出现了三种或更多种抑郁症状。41%的照顾者报告 HIV 阳性。自我报告的 HIV 阳性状态与抑郁症状相关（调整后的系数=0.355，p 值<0.001），进而与照顾者的 ART 坚持情况较差相关（比值比 0.639，p 值=0.023）。对于报告 HIV 阳性的照顾者（系数=0.302，p 值=0.028）和报告 HIV 阴性的照顾者（系数=0.187，p 值<0.001），HIV 相关污名也与抑郁症状相关。拥有社会支持与较低的抑郁症状相关（系数=-0.115，p=0.007）。HIV 相关污名、拥有社会支持和其他社会人口特征与 ART 坚持无关。
在脆弱家庭中关注照顾者的心理健康可能是实现马拉维 HIV 感染者病毒抑制的重要一步。将抑郁筛查纳入 HIV 护理和治疗方案可能是改善长期结果的有前途的干预措施。
