Population Council, Lusaka, Zambia; and.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Acquir Immune Defic Syndr. 2023 Jul 1;93(3):191-198. doi: 10.1097/QAI.0000000000003193.
In Zambia, half of children and adolescents living with HIV (CALWH) on antiretroviral therapy (ART) are virologically unsuppressed. Depressive symptoms are associated with ART nonadherence but have received insufficient attention as mediating factors in the relationship between HIV self-management and household-level adversities. We aimed to quantify theorized pathways from indicators of household adversity to ART adherence, partially mediated by depressive symptoms, among CALWH in 2 Zambian provinces.
In July-September 2017, we enrolled 544 CALWH aged 5-17 years and their adult caregivers into a year-long prospective cohort study.
At baseline, CALWH-caregiver dyads completed an interviewer-administered questionnaire, which included validated measures of recent (past 6 months) depressive symptomatology and self-reported past-month ART adherence (never versus sometimes or often missing medication doses). We used structural equation modeling with theta parameterization to identify statistically significant ( P < 0.05) pathways from household adversities (past-month food insecurity and caregiver self-reported health) to depression (modeled latently), ART adherence, and poor physical health in the past 2 weeks.
Most CALWH (mean age: 11 years, 59% female) exhibited depressive symptomatology (81%). In our structural equation model, food insecurity significantly predicted elevated depressive symptomatology ( ß = 0.128), which was associated inversely with daily ART adherence ( ß = -0.249) and positively with poor physical health ( ß = 0.359). Neither food insecurity nor poor caregiver health was directly associated with ART nonadherence or poor physical health.
Using structural equation modeling, we found that depressive symptomatology fully mediated the relationship between food insecurity, ART nonadherence, and poor health among CALWH.
在赞比亚，接受抗逆转录病毒疗法（ART）的半数 HIV 阳性儿童和青少年（CALWH）病毒学抑制效果不佳。抑郁症状与 ART 不依从相关，但作为 HIV 自我管理与家庭层面逆境之间关系的中介因素，受到的关注不足。我们旨在量化家庭逆境指标与 ART 依从性之间的理论途径，这些途径部分通过抑郁症状在赞比亚两省的 CALWH 中起中介作用。
2017 年 7 月至 9 月，我们招募了 544 名年龄在 5-17 岁的 CALWH 及其成年照顾者，进入一项为期一年的前瞻性队列研究。
在基线时，CALWH-照顾者对完成了一份由访谈者管理的问卷，其中包括最近（过去 6 个月）抑郁症状和自我报告的过去一个月 ART 依从性（从未、有时或经常漏服药物）的经过验证的测量。我们使用具有θ参数化的结构方程模型来确定从家庭逆境（过去一个月的食物不安全和照顾者自我报告的健康状况）到抑郁（潜在模型）、ART 依从性和过去两周身体不佳的统计学显著（P <0.05）途径。
大多数 CALWH（平均年龄：11 岁，59%为女性）表现出抑郁症状（81%）。在我们的结构方程模型中，食物不安全显著预测了抑郁症状的升高（β=0.128），这与每日 ART 依从性呈负相关（β=-0.249），与身体不佳呈正相关（β=0.359）。食物不安全和照顾者健康状况不佳均与 ART 不依从或身体不佳无直接关系。
使用结构方程模型，我们发现抑郁症状完全中介了 CALWH 中食物不安全、ART 不依从和健康不佳之间的关系。
