Impact of depression on adherence to antiretroviral therapy among hiv/aids patients attending the comprehensive care center at kenyatta national hospital

Abstract

Background: As more and more Kenyans infected with the Human Immunodeficiency Virus /Acquired Immune Deficiency Syndrome ((HIV)/AIDS) are being initiated on therapy in Kenya, health care workers are faced with an increasing challenge of co-morbid psychological and social factors among these patients which have a profound impact on patients adhering to medication. A major psychosocial factor that is a barrier in adherence to therapy is depression associated with HIV. This study aimed at measuring the effect of depression on the participants' own reported adherence to highly active antiretroviral therapy. Methodology: A cross-sectional study design was used whereby the data was collected using a researcher designed structured questionnaire. Adult HIV infected participants attending the KNH CCC who were 18 years old and above and were on antiretroviral therapy were recruited. They were screened for depressive symptoms with the patient health questionnaire version 9, (PHQ 9), to find out whether depression was a risk factor in poor adherence to antiretroviral drugs. Adherence was measured by self report and pill counts. Data entry and analysis was performed using SPSS version 17.0, which has inbuilt verification and range check capabilities to ensure clean data. Data descriptive analysis of all variables was done and summarized into frequency tables and charts. Kruskal Wallis test was used to compare medians for skewed data. The chi square test was used to test for statistical significance. Ethical approval was sought from and granted by the Kenyatta National HospitallUniversity of Nairobi ethical review committee before commencing with the study. Results: Three hundred and eighty four (384) participants were recruited for the study, of whom 60.2 % (231) were female and 39.8 % (153) were male. The median age was 41-50 years old. The prevalence of depression was found to be 23.3 %. Of these, the prevalence of mild, moderate and severe depression as measured on the PHQ 9 was found to be 21.2 %, 1.8 % and 0.3 % respectively. The mean non adherence rate (mean non adherence rate over one XIII month and average mean adherence rate over three months) was 27.9 % and 22.4 % respectively. Conclusion: The findings of this study provided evidence of a minimal relationship between depression and non adherence to antiretroviral therapy among adult HIV infected patients. Depression associated with HIV/AIDS was not significantly associated with adherence to antiretroviral therapy. Recommendations: The study recommends that HIV/AIDS strategic plans should be formulated in combating depression associated with HIV/AIDS. Patient mental health education programmes should be introduced in HIV management centres to increase awareness and offer psychiatric counselling to HIV infected patients. Regular screening and treatment of depression among HIV infected patients may be introduced in HIVIAIDS management centres. XIV