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Journal article
Perinatal Depressive Symptoms, Human Immunodeficiency Virus (HIV) Suppression, and the Underlying Role of Antiretroviral Therapy Adherence: A Longitudinal Mediation Analysis in the IMPAACT P1025 Cohort
Clinical infectious diseases, v 73(8), pp 1379-1387
20 Oct 2021
PMID: 33982083
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Women with HIV have higher risk of depressive symptoms in the perinatal period. Evidence on how perinatal depressive symptoms affect viral suppression (VS) and adherence to antiretroviral therapy (ART) remains limited.
Perinatal depressive symptoms were assessed using 6 items from the AIDS Clinical Trials Group (ACTG) Quality of Life questionnaire. VS (viral load <400 copies/mL) was the outcome. Adherence was defined as no missed dose in the past 1-4 weeks using the ACTG Adherence Questionnaire. Generalized mixed-effects structural equation models estimated the association of depressive symptoms on VS and the mediating role of ART adherence among women enrolled in the IMPAACT P1025 Perinatal Core Protocol (2002-2013).
Among 1869 participants, 47.6% were 21-29 years, 57.6% non-Hispanic Black. In the third trimester, the mean depressive symptoms score was 14.0 (±5.2), 68.0% had consistent adherence, and 77.3% achieved VS. At 6 months postpartum, depressive symptoms declined while adherence and VS fell to 59.8% and 53.0%, respectively. In the fully adjusted model, a 1-SD increase in depressive symptoms was associated with a 3.8-percentage-point (95% CI: -5.7, -1.9) decline in VS. This effect is the sum of the indirect effect of depressive symptoms on VS via ART adherence (-0.4; 95% CI: -.7, -.2) and the direct effect through other pathways (-3.4; -5.2, -1.5). The decline in adherence driven by depressive symptoms accounted for ≥11% of the total negative effect of depressive symptoms on VS.
Perinatal depressive symptoms were associated with decreased adherence and VS, highlighting the need to screen for, diagnose, and treat perinatal depression to optimize maternal outcomes.
NCT00028145.
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Details
- Title
- Perinatal Depressive Symptoms, Human Immunodeficiency Virus (HIV) Suppression, and the Underlying Role of Antiretroviral Therapy Adherence: A Longitudinal Mediation Analysis in the IMPAACT P1025 Cohort
- Creators
- Florence Momplaisir - University of PennsylvaniaMustafa Hussein - University of Wisconsin–MilwaukeeDeborah Kacanek - Harvard UniversityKathleen Brady - AIDS Activities Coordinating OfficeAllison Agwu - Johns Hopkins MedicineGwendolyn Scott - University of MiamiRuth Tuomala - Brigham and Women's HospitalDavid Bennett - Drexel University
- Publication Details
- Clinical infectious diseases, v 73(8), pp 1379-1387
- Publisher
- Oxford University Press
- Grant note
- UM1 AI068616 / NIAID NIH HHS National Institute of Child Health and Human Development P30 AI045008 / NIAID NIH HHS UM1AI068632 / NIH HHS HHSN275201800001I / NICHD NIH HHS IMPAACT Network's Scholar's Program NIMH NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Psychiatry
- Web of Science ID
- WOS:000729893700008
- Scopus ID
- 2-s2.0-85112704402
- Other Identifier
- 991019168697004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Immunology
- Infectious Diseases
- Microbiology