Depression and Engagement in Care Among Newly Diagnosed HIV-Infected Adults in Johannesburg, South Africa.
Depression and Engagement in Care Among Newly Diagnosed HIV-Infected Adults in Johannesburg, South Africa.
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DOI：
10.1007/s10461-016-1442-6
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发表时间：
2017-06
影响因子：
4.4
通讯作者：
Miller WC
中科院分区：
文献类型：
--
作者：
Cholera R;Pence BW;Gaynes BN;Bassett J;Qangule N;Pettifor A;Macphail C;Miller WC
在撒哈拉以南非洲，延迟参与艾滋病毒护理威胁着艾滋病毒治疗计划的成功，并可能受到抑郁症的影响。我们在南非约翰内斯堡的一家初级保健诊所研究了艾滋病毒诊断前抑郁症与参与艾滋病毒护理之间的关系。我们筛选了1683例患者的抑郁症之前，艾滋病毒检测使用患者健康问卷-9。在HIV检测呈阳性的患者中，我们评估了与HIV护理的联系，定义为在3个月内获得CD 4计数。在那些与护理有关并有资格接受ART的患者中，我们评估了3个月内开始ART的情况。多变量泊松回归与稳健的方差估计被用来评估抑郁症和链接到护理或ART启动之间的关联。HIV感染率为26%（n = 340）。在艾滋病毒感染者中，抑郁症的患病率为30%。抑郁症患者与护理相关的比例为80%，非抑郁症患者为73%（风险比1. 08; 95%置信区间0. 96，1. 23）。在与护理有关的参与者中，抑郁组和非抑郁组中有81%的人在3个月内开始ART（风险比0.99; 95%置信区间0.86，1.15）。在南非的初级保健环境中，抑郁症与参与艾滋病毒护理无关。我们意想不到的发现表明，一些抑郁的艾滋病毒感染者可能比没有抑郁症的患者更有可能参与护理，并强调了抑郁症和艾滋病毒感染之间的复杂关系。这些发现使我们提出了一个新的框架，将艾滋病毒感染、抑郁症和研究人群联系起来。
Delayed engagement in HIV care threatens the success of HIV treatment programs in sub-Saharan Africa and may be influenced by depression. We examined the relationship between depression prior to HIV diagnosis and engagement in HIV care at a primary care clinic in Johannesburg, South Africa. We screened 1683 patients for depression prior to HIV testing using the Patient Health Questionnaire-9. Among patients who tested positive for HIV we assessed linkage to HIV care, defined as obtaining a CD4 count within 3 months. Among those who linked to care and were eligible for ART, we assessed ART initiation within 3 months. Multivariable Poisson regression with a robust variance estimator was used to assess the association between depression and linkage to care or ART initiation. The prevalence of HIV was 26 % (n = 340). Among HIV-infected participants, the prevalence of depression was 30 %. The proportion of linkage to care was 80 % among depressed patients and 73 % among patients who were not depressed (risk ratio 1.08; 95 % confidence interval 0.96, 1.23). Of the participants who linked to care, 81 % initiated ART within 3 months in both depressed and not depressed groups (risk ratio 0.99; 95 % confidence interval 0.86, 1.15). Depression was not associated with engagement in HIV care in this South African primary care setting. Our unexpected findings suggest that some depressed HIV-infected patients might be more likely to engage in care than their counterparts without depression, and highlight the complex relationship between depression and HIV infection. These findings have led us to propose a new framework relating HIV infection, depression, and the population under study.
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影响因子：
4.4
作者：
Bhatia, Ramona;Hartman, Christine;Giordano, Thomas P.
通讯作者：
Giordano, Thomas P.
影响因子：
11.1
作者：
Park, W. B.;Choe, P. G.;Choe, K. W.
通讯作者：
Choe, K. W.
影响因子：
4.4
作者：
Lawler, Kathy;Mosepele, Mosepele;Steenhoff, Andrew
通讯作者：
Steenhoff, Andrew
影响因子：
2.2
作者：
Hughes, J;Jelsma, J;Tinise, X
通讯作者：
Tinise, X
影响因子：
2.7
作者：
Berghoefer, Anne;Roll, Stephanie;Pfennig, Andrea
通讯作者：
Pfennig, Andrea