Assessing the association between depression and viral load suppression among adolescents and youth living with HIV (15–24 years) in Malawi: Insights from Malawi Population-based HIV Impact Assessment (MPHIA) 2020–2021 survey

Ndhlovu, Grace

Assessing the association between depression and viral load suppression among adolescents and youth living with HIV (15–24 years) in Malawi: Insights from Malawi Population-based HIV Impact Assessment (MPHIA) 2020–2021 survey

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Background Despite advancements in HIV antiretroviral therapy (ART), suboptimal viral load suppression (VLS) persists among adolescents and youth living with HIV (AYLWH) in Malawi. Depressive symptoms are hypothesized to affect VLS, complicating HIV management. However, limited data exist from Malawi and the broader African region examining the relationship between depressive symptoms and VLS. This study examines the association between depressive symptoms and VLS among AYLWH, leveraging secondary data from the Malawi Population-based HIV Impact Assessment (MPHIA) 2020–2021. Methods A cross-sectional analysis of AYLWH aged 15–24 years was conducted. VLS was defined as HIV RNA <200 copies/mL. Depressive symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2), with a cut-off score of ≥3 indicating the presence of depressive symptoms. Weighted univariable and multivariable logistic regression analyses were performed to explore associations between depressive symptoms and VLS, adjusting for covariates such as gender, education level, type of residence, wealth quintile, ever using alcohol, psychosocial intervention participation, and awareness of HIV status. Results Among 201 AYLWH, 68% achieved VLS and 3% reported depressive symptoms. Among participants who had achieved VLS, 70% lived in rural areas, and 91% were aware of their HIV status. Depressive symptoms were not significantly associated with VLS in both univariable (OR: 0.8, 95% CI: 0.1–4.6, p=0.801) and multivariable models (OR: 0.3, 95% CI: 0.1–2.4, p=0.276). Significant predictors of VLS included type of residence (urban vs rural; adjusted OR: 0.2, 95% CI: 0.1–0.5, p=0.002) and awareness of HIV status (adjusted OR: 0.1, 95% CI: 0–0.1, p<0.001). Gender, education, wealth quintile, ever using alcohol, and participation in psychosocial interventions were not significantly associated with VLS. Conclusion While depressive symptoms were not significantly associated with VLS, the findings highlight the critical role of structural factors such as residence and awareness of HIV status in improving VLS. The low prevalence of depressive symptoms may reflect limitations in the assessment tools or underreporting. Integrating robust mental health interventions into HIV care services may address barriers to VLS and improve outcomes for AYLWH in Malawi. Further longitudinal studies are recommended to elucidate the interplay between mental health and HIV outcomes.

Keywords

HIV

depression

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