Mental health and antiretroviral therapy adherence among people living with HIV attending an HIV clinic in Blantyre, Malawi

Master Thesis


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ABSTRACT Background: Tremendous progress has been achieved in the treatment for HIV/AIDS since the 1980s. This significant improvement and progress in HIV treatment has largely been attributed to antiretroviral therapy (ART). Non-adherence to ART commonly causes ART treatment failure and the development of drugresistant strains of HIV, resulting in increased mortality. Common mental disorders have been found to be strongly associated with non-adherence. In Malawi, where HIV is prevalent, there is a paucity of studies on how common mental disorders are associated with non-adherence. The present study aimed at examining the association between depression, anxiety and alcohol use disorder symptoms and ART adherence among people living with HIV/AIDS (PLWHA) attending an HIV clinic in Blantyre, Malawi. Methods: This was a facility-based quantitative study with a cross-sectional descriptive design with 213 PLWHA attending an HIV clinic. The participants completed a survey consisting of demographics and mental health disorders symptoms screening tools, namely the 9-item Patient Health Questionnaire (PHQ9) for depression symptoms, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms and the Alcohol Use Disorders Identification Test (AUDIT) for alcohol use and related harms. ART adherence was assessed using pill count, a self-report measure and a combined measure of both pill count and self-report adherence. Results: The prevalence of depressive symptoms among the participants was 32%, 26% for anxiety symptoms and 16% of participants reported any life-time alcohol use. The majority of participants (75.6%) were found to have good pill count-based adherence while only 41.7% and 33.2% of participants reported good adherence on the self-report and combined measures respectively. The results showed that older participants were more likely to self-report good adherence than younger participants (OR=1.03; 95%CI=1.01-1.06, p-value=0.050). The participants who scored higher on the AUDIT were less likely to self-report good adherence to ART (OR=0.88; 95% CI=0.78-1.00, p-value=0.050). Side-effects were statistically significantly associated with both pill-count and combined adherence. The participants that experienced side effects from the treatment were less likely to be adherent on pill count (OR=0.19; 95% CI=0.07-0.53, p-value=0.001) and the combined adherence measure (OR=0.45; 95% CI=0.24-0.83, pvalue=0.011). Alcohol use was again significantly associated with combined adherence. The participants who reported ever having used alcohol were less likely to be adherent to ART on the combined adherence measure (OR=0.51; 95% CI=0.29-0.93, p-value=0.026). No statistically significant association between depressive and anxiety symptoms and ART adherence was found. Conclusion: The findings show that symptoms of common mental disorders were highly prevalent among PLWHA. Alcohol use, younger age group and experiencing side-effects from ART were significantly associated with ART non-adherence. Further research is required to investigate how depression and anxiety is associated with ART adherence among PLWHA in a Malawian population using larger sample sizes. The current study also highlights the need to routinely screen PLWHA for mental health problems. Further research using advanced designs, such as randomized clinical trials incorporating implementation science approaches, is also needed to evaluate the feasibility and effectiveness of integrating mental health services into HIV care in Malawi.