The Association Between Depression and Non-adherence to Antiretroviral Therapy Among Pregnant Women Living With Hiv A Cross-sectional Study at the Antenatal Clinic of Kibera South Health Centre, Nairobi

Abstract

Background: Depression is progressively becoming a worldwide concern. Lower and middle-income countries carry a higher burden of maternal depression. Depression in the period of pregnancy particularly in context of HIV is of worrying because of its possible impact on maternal and child health. Depression may interfere with HIV care as studies have demonstrated a relationship between depression and non-adherence to Anti-Retroviral Treatment. Poor adherence to Anti-Retroviral Therapy during pregnancy increases the likelihood of mother to child transmission of HIV Objective: This study aimed at establishing whether there is a relationship between depression during pregnancy and adherence to ART amongst the pregnant women who are living with HIV and were attending clinic at the Kibera South Health Centre. Study Design: Cross sectional study Methodology: Pregnant women living with HIV were screened for depression using the EPDS. Data on adherence to ART was collected using the CASE adherence index. A researcher designed questionnaire was administered to obtain data on socio-demographic, psychological, and practical barriers to care and engagement with health care facility. Data analysis: Data entry and analysis was carried out using SPSS version 21. Socio-demographic and clinical variables were represented in frequency tables. This was followed by bivariate analysis whereby the factors associated with depression and also factors associated with non-adherence were determined. Finally, a multivariate analysis was done to determine the risk factors in both depression and non-adherence among the respondents Results:35% of the pregnant women living with HIV at Kibera South Health Centre suffered from depression. 24.3 % of them were non-adherent to ART medication. Risk factors associated with depression were young maternal age 18 to 24 years OR=10.39, 95% CI (2.52-42.75). Other risk factors for depression were experience of

intimate partner violence OR=5.27, 95% CI (2.13-13.00). Young maternal age (18 to 23 years) was also associated with non-adherence, OR=6.84, 95% CI (1.67-28.08) After adjusting for all other factors associated with non-adherence; we found out that participants who were not depressed had significantly lower levels of non-adherence to ART medication; AOR=0.18;(p=0.017) Conclusion: Depression in HIV infection leads to non-adherence to ART medication. Participants who were not depressed had significantly lower levels of non-adherence to ART medication; AOR=0.18;(p=0.017) These findings highlight the need to address mental health issues particularly depression in pregnancy in terms of assessment & treatment. This will in turn serve as a mechanism to ensure good adherence and therefore provide further support for the current effort to eliminate mother to child transmission of HIV in Kenya.