Perinatal depression and key care outcomes in pregnant Malawian women with HIV

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Project summary/Abstract Antiretroviral treatment (ART) for HIV-infected persons is effective at reducing new HIV infections. In sub- Saharan Africa, women of reproductive age are an important target for ART in order to improve their own health as well as to prevent HIV transmission to their sexual partners and their infants. In Malawi, a country in southern Africa, HIV prevalence in adult women is high at 13%. Malawi was the first country in sub-Saharan Africa to adopt “Option B+,” a World Health Organization initiative to start and maintain all HIV-infected pregnant women on lifelong ART regardless of CD4 count, a significant expansion in ART eligibility criteria. Option B+ has the potential to substantially reduce HIV transmission and women's morbidity and mortality, but only if women can be retained on ART long-term with the high adherence required to sustain viral suppression. The Option B+ program has led to a dramatic increase in the number of women starting ART in Malawi, but efforts at keeping women in HIV care, on treatment, and virally suppressed post-delivery have fallen short. Retention in HIV care, ART adherence, and viral suppression are influenced by potentially modifiable psychosocial factors, including perinatal depression. Depression is more common among HIV-infected persons than among the general population. While depression has been shown to negatively impact HIV outcomes in the United States, no studies have examined the impact of perinatal depression on retention in care and viral suppression among HIV-infected pregnant women in Africa. The overall objective of this Kirschstein-NRSA individual fellowship (F30) proposal is to identify the influence perinatal depression on two key HIV care outcomes – retention in care and viral suppression – among HIV-infected pregnant women in Malawi. The results will establish the burden and timing of perinatal depression in the growing Option B+ population and inform future policy decisions regarding mental health care for HIV-infected women in Malawi and possibly other Option B+ sub-Saharan African countries. The specific aims of this proposal are: 1) Estimate the prevalence and incidence of perinatal depression; 2) Identify predictors of incident postpartum depression; and 3) Estimate the association of perinatal depression with retention in care and viral suppression. The proposed research is nested within an ongoing longitudinal cohort study designed to examine the long-term safety and efficacy of the Option B+ program in Malawi. Through this research project and a carefully constructed training plan, the trainee will achieve the following fellowship goals: 1) develop advanced skills in population-based study design, data collection, analysis, and communication of results; 2) acquire skills in clinical and translational research to facilitate integration of clinical and research pursuits; and 3) develop professional skills that will facilitate a successful academic career.