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Cited by 466HIV/AIDS Research and InterventionsMedication Adherence and ComplianceHIV, Drug Use, Sexual Risk

Depression and Adherence to Antiretroviral Therapy in Low-, Middle- and High-Income Countries: A Systematic Review and Meta-Analysis

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Uthman, Olalekan A., Magidson, Jessica F., Safren, Steven A., Nachega, Jean B.·2014·Current HIV/AIDS Reports
DOI 10.1007/s11904-014-0220-1PMC PMC4359613
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Abstract

We investigated the associations between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV). We searched the PubMed, EMBASE and Cochrane CENTRAL databases for studies that reported an association between depression and adherence to ART as a primary or secondary outcome. We used a random-effect model to pool the risk estimates from the individual studies. The odds ratio (OR) with their 95 % CIs were used as summary estimates. Of 2861 citations, 111 studies that recruited 42,366 PLHIV met our inclusion criteria. When reported, the rate of PLHIV with depressive symptoms ranged from 12.8 to 78 % and the proportion of PLHIV who achieved good adherence (≥ 80 %) ranged from 20 to 98 %. There were no significant differences in rate of depressive symptoms in PLHIV by country income group; however, the proportion of PLHIV who achieved good adherence was significantly higher in lower-income countries (as defined in the 2012 World Bank Country Income Groups) (pooled rate=86 %) compared to higher-income countries (pooled rate=67.5 %; p< .05). We found that the likelihood of achieving good ART adherence was 42 % lower among those with depressive symptoms compared to those without (pooled OR=0.58, 95 % CI 0.55 to 0.62). The relationship between depressive symptoms and adherence to ART was consistent across the country's income group, study design and adherence rates. We found that the magnitude of the association significantly decreases with more recent publications and increasing study sample size. The higher the prevalence of depressive symptoms of PLHIV recruited in the studies, the lower the likelihood of achieving good adherence to ART. In conclusion, the likelihood of achieving good adherence was lower among those with depressive symptoms compared to those without.

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  • HIV-related stigma can compromise health behaviours such as adherence to antiretroviral therapy among people living with HIV.

    “PLWH also experience HIV-related stigma which exacerbates mental health problems (Levi-Minzi &amp; Surratt, 2014) and can compromise health behaviours such as adherence to life-saving antiretroviral therapy (ART) (Remien et al., 2019; Uthman et al., 2014).”

    From Resilience resources for mental health among people living with HIV: a mixed-method systematic review (2024) · cites this paper as Uthman et al., 2014

    The Introduction reports that depressive symptoms can disrupt ART adherence among people living with HIV, and the Results report lower adherence among those with depressive symptoms. The paper does not establish the attributed link between HIV-related stigma and adherence; a search for “stigma” found no passage addressing it. (LLM, conf=0.78)

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Cited by

Sorted by citations

Authors
Uthman, O. A., Magidson, J. F., Safren, S. A., & Nachega, J. B.
Affiliations
  • University of Warwick (GB)
  • Harvard University (US)
  • Johns Hopkins University (US)
Corresponding author
Nachega, Jean B.
ORCID
Venue
Current HIV/AIDS Reports
Publisher
Springer Science and Business Media LLC
Published
2014-07-20
Volume
11
Issue
3
Pages
291-307
ISSN
  • 1548-3568 (ISSN-L)
  • 1548-3576
DOI
10.1007/s11904-014-0220-1
PMC
PMC4359613
OpenAlex
W2150490647
Cited by
466
References
6
Citations by year
2026: 31 · 2025: 33 · 2024: 58 · 2023: 44 · 2022: 49 · 2021: 62 · 2020: 39 · 2019: 33 · 2018: 46 · 2017: 36 · 2016: 21 · 2015: 12 · 2014: 2
FWCI
3.29
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Current HIV/AIDS Reports (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (submittedVersion)
Funders
  • U.S. President’s Emergency Plan for AIDS Relief
  • Wellcome Trust (WT087537MA)
  • National Institute of Mental Health (K24MH094214, T32MH093310)
  • National Institute of Allergy and Infectious Diseases (UM1AI069521)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
depression, depressive symptoms, antiretroviral therapy adherence, people living with HIV, HIV, country income level, low- and middle-income countries, adherence rates
MeSH terms
Assessment of Medication Adherence, Depression, Developing Countries, HIV Infections, Drug Monitoring, Developed Countries, Anti-HIV Agents, Medication Adherence

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