The Prevalence and Factors Associated With Depression Among People Living With Hiv on Antiretroviral Treatment at Kenyatta National Hospital

Abstract

Background: The definition of depression is a common mental health illness, characterized by loss of interest or pleasure, sadness, tiredness, poor concentration, feelings of low self-esteem or guilt, lack of sleep or sleeping too much or lack of appetite or eating too much. It is the most prevalent psychiatric disorder among people living with HIV (PLWH), where 13% to 78% are affected in comparison to 5% of the general population. In sub-Saharan Africa it ranges from 14 to 32% among those on antiretroviral treatment (ART). In Kenya, among PLWH major depressive disorder is estimated to be 32% while other depressive disorders are estimated to be 15%. Despite major strides to roll out ART leading to reduction in HIV related morbidity and mortality, it is estimated by 2030 HIV and depression will be the leading causes of disability, which may lead to unemployment, and poor quality of life, increased suicidal risk, and non-adherence to ART. The socio-demographic factors include marital status, age. gender, low education level, and low income or unemployment. Other factors associated with depression include, duration on ART regimen, WHO HIV stage, viral load, comorbidities, status disclosure, stigma, substance use and intimate partner violence. Thus, the aim of this study was to determine the prevalence and factors of depression among PLWH on ART in Kenyatta National Hospital. Methods: This was a cross-sectional study conducted at the Comprehensive Care Center, in Kenyatta National Hospital from March to June 2024, to include PLWH on ART who provide a written informed consent and were at least 18 years old. Depression was measured using the patient health questionnaire (PHQ-9) and standardized tools were used to measure factors to include alcohol and substance use, intimate partner violence (IPV), stigma and social support. The association between each factor and depression was estimated using log binomial models and factors associated with depression in the univariate model (p<0.05) were put simultaneously in the multivariate model to identify independent factors associated with depression. All analyses will be conducted using Stata 15.0 (StataCorp, College Station, TX). Results: The study enrolled 299 participants. The prevalence of depression (Phq 9 score ≥ 5) was 24.7%. The median age was 43 years (IQR=30–51). The Majority of the participants were female 171 (57.2 %), married 118 (39.5%), Christian 287 (96.05), attained tertiary education 119 (39.8%), self-employed 127 (42.5%) and earned<Ksh. 10,000, 150 (50.2%). Majority of the participants were on1st line ART regimen 258 (86.3%), had a viral load between 40 -100,000 copies 279 (93.3%), were in and were in vii Version 1 dated 4th July 2024 WHO stage one 166 (55.1%). Some participants had comorbidities such as diabetes 11 (3.7%) and hypertension 46 (15.3%). The median score for HIV stigma was 29 (IQR 26- 32), where majority of participants had disclosed their HIV status 266 (89%), had moderate social support 152 (50.8%), did not drink alcohol 227 (75.9%) and did not use substances 277 (92.6%), and most had emotional IPV 120 (40.1%). In the univariate analysis the factors significantly associated with depression included being female (OR 1.79, 95% CI 1.04-3.18, p-value 0.04), divorced (OR 5.22, 95% CI 1.08-28.2, p-value 0.04), WHO HIV stage 3 (OR 2.08, 95% CI 1.08-3.99, p-value 0.03), emotional (OR 2.47, 95% CI 1.45-4.25, p-value 0.00, physical (OR 3.77, 1.58-9.08, pvalue 0.003) and sexual (OR5.70, 95% CI 2.04-17.3, p value 0.001), intimate partner violence (IPV), poor social support (OR 2.41, 95% CI 1.07-5.85, p-value 0.04) HIV stigma (OR 1.09, 95% CI 1.04- 1.15, p-value 0.001) and substance use (OR 2.77, 95% CI 1.12-6.73, p-value 0.03). Factors that remained significantly associated with depression in the multivariate analysis included being female (AOR 2.22, 95% CI 1.13- 4.48, p-value 0.02), WHO HIV stage 3 (AOR 2.41, 95% CI 1.08-5.37, p-value 0.03), emotional IPV (AOR 2.28, 95% CI 1.20-4.38, p-value 0.01), sexual IPV (AOR 3.87, 95% CI 1.15-13.7, p-value 0.03), HIV stigma (AOR 1.08, 95% 1.02-1.14, p-value 0.01) and substance use (AOR 4.29, 95% CI 1.50 – 12.3, p-value 0.01). In conclusion there was a high prevalence of depression among PLHIV on ART at the KNH CCC. Thus, PLHIV on ART should be screened for depression, and there should be interventions to prevent IPV, substance use and HIV stigma.