Johnson Ann E, Chimoyi Lucy, Shenoi Sheela, Brault Marie A, Forastiere Laura, Charalambous Salome, Chihota Violet, Davis J Lucian
Yale School of Medicine, New Haven, Connecticut, USA.
Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA.
Open Forum Infect Dis. 2025 Jun 4;12(6):ofaf303. doi: 10.1093/ofid/ofaf303. eCollection 2025 Jun.
Because of the association of mental health and substance use disorders with higher HIV mortality and decreased retention in care, we investigated their frequency and impact on tuberculosis preventive therapy (TPT) adherence and completion among people with HIV (PWHIV) initiating TPT.
We conducted a prospective, longitudinal cohort study with a nested mixed methods study in 2 Johannesburg, South Africa, facilities. Participants were PWHIV on antiretroviral therapy initiating TPT between August and December 2023. We measured TPT adherence and completion with electronic medication boxes. We used validated tools to measure symptoms of anxiety, depression, alcohol use, and other substance use at enrollment and 12 weeks. We constructed multivariable regression models to determine associations of these variables with TPT adherence and completion, adjusting for age, sex, and time on antiretroviral therapy. We interviewed participants about mental health and experiences with TPT and analyzed responses using deductive content analysis.
Among 224 PWHIV, 111 (50%) completed TPT. Eighty-one (36%) screened positive for depression symptoms and 63 (28%) for anxiety symptoms. Seventy-six (34%) reported unhealthy alcohol use and 60 (27%) tobacco use. Using multivariable models adjusting for confounders, only depression symptoms were significantly and negatively associated with adherence (9% fewer doses; 95% confidence interval, .4-16; = .032) and completion (odds ratio, 0.48; 95% confidence interval, .26-.90; = .021). Participant narratives highlighted the negative influence of mental health on adherence and the need for social and psychological support services.
Symptoms of depression, anxiety, unhealthy alcohol use, and tobacco use were common among PWHIV initiating TPT. Depression symptoms were strongly and independently associated with TPT nonadherence and noncompletion.
由于心理健康和物质使用障碍与较高的HIV死亡率以及护理留存率降低相关，我们调查了它们在开始接受结核病预防性治疗（TPT）的HIV感染者（PWHIV）中的发生率及其对TPT依从性和完成率的影响。
我们在南非约翰内斯堡的2个机构进行了一项前瞻性纵向队列研究，并嵌套了混合方法研究。参与者为2023年8月至12月期间开始接受抗逆转录病毒治疗并启动TPT的PWHIV。我们使用电子药盒测量TPT的依从性和完成率。我们使用经过验证的工具在入组时和12周时测量焦虑、抑郁、酒精使用及其他物质使用的症状。我们构建了多变量回归模型，以确定这些变量与TPT依从性和完成率之间的关联，并对年龄、性别和抗逆转录病毒治疗时间进行了调整。我们就心理健康和TPT经历对参与者进行了访谈，并使用演绎性内容分析法分析了回答。
在224名PWHIV中，111名（50%）完成了TPT。81名（36%）抑郁症状筛查呈阳性，63名（28%）焦虑症状筛查呈阳性。76名（34%）报告有不健康饮酒行为，60名（27%）报告有吸烟行为。使用调整了混杂因素的多变量模型，只有抑郁症状与依从性（剂量减少9%；95%置信区间，0.4 - 16；P = 0.032）和完成率（比值比，0.48；95%置信区间，0.26 - 0.90；P = 0.021）显著负相关。参与者的叙述强调了心理健康对依从性的负面影响以及对社会和心理支持服务的需求。
在开始接受TPT的PWHIV中，抑郁、焦虑、不健康饮酒和吸烟症状很常见。抑郁症状与TPT不依从和未完成密切且独立相关。
