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Research
Yilkal Muchie Dires
All Africa TB Leprosy and rehabilitation training center (ALERT)
Corresponding Author
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Background: Virological non-suppression remains the major cause of treatment failure and mortality among adolescents and youth living with HIV in low- and middle-income countries (LMICs). Behavioral and mental health disorders affect adherence to antiretroviral therapy (ART) and the underlying virological suppression, but evidence from LMICs is relatively limited. We aimed to assess HIV virological non-suppression and associated factors among adolescents and youth attending ART in Ethiopia.
Methods: A 1:2 matched facility-based case-control study was conducted at ALERT Hospital, Addis Ababa, Ethiopia, among patients with HIVaged 12-24 years who were on ART and with a viral load > (case) or < (control) than 1000 copies/ml after at least six months on ART. The primary outcome was viral load non-suppression: a plasma viral load > 1000 copies/ ml based on two consecutive viral load measurements every three months. The primary exposure was depressive symptoms as measured using the PHQ-9 (Patient Health Questionnaire, 9-item version). Other variables include adherence to ART and sociodemographic characteristics of participants. Data were collected using structured, blinded lay interviewer-administered questionnaires, and data extraction forms. Conditional multivariable logistic regression was conducted using STATA version 14.2 to test the main hypotheses.
Results: The study enrolled 192 participants, with a median age of 18 years and 52.1% males. None of the participants reported smoking or chewing Khat (a leaf that stimulates mood). With the PHQ-9 tool, 47%, 28%, and 25% had minimal or no, probable to mild and moderate to severe depression symptoms, respectively. Having depressive symptoms is associated with a higher conditional likelihood of virological failure (odds ratio [OR] = 1.8, p < 0.001) and the association was stronger among those who have moderate or severe depressive symptoms (adjusted OR = 5, 95% CI [1.7-14.6] )and unadjusted OR = 6.8, 95% CI [3.1-14.8]). Having moderate and severe depression is associated with non-adherence to ART (adjusted OR = 10.5).
Conclusion: Non-adherence to ART medications, depressive symptoms, advanced WHO stage on ART initiation, poor social support and orphan status were independently associated with virological failure among HIV-infected adolescents and youths on ART. Having moderate and severe depression has higher odds of non-adherence and virological failure. We recommend integration and task-sharing of mental health and HIV care services to reduce virological failure in this group of people.
Keywords
Virological non-suppression, HIV, depression, mental health, adolescents and youth, Ethiopia.
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This preprint is under consideration at AIDS Research and Therapy. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Yilkal Muchie Dires
All Africa TB Leprosy and rehabilitation training center (ALERT)
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 16 Nov, 2021
No community comments so far
Reviewers invited
Invitations sent on 18 Nov, 2021
Editor assigned
On 12 Nov, 2021
Submission checks complete
On 11 Nov, 2021
Editor invited
On 11 Nov, 2021
First submitted
On 24 Oct, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Virological non-suppression remains the major cause of treatment failure and mortality among adolescents and youth living with HIV in low- and middle-income countries (LMICs). Behavioral and mental health disorders affect adherence to antiretroviral therapy (ART) and the underlying virological suppression, but evidence from LMICs is relatively limited. We aimed to assess HIV virological non-suppression and associated factors among adolescents and youth attending ART in Ethiopia.
Methods: A 1:2 matched facility-based case-control study was conducted at ALERT Hospital, Addis Ababa, Ethiopia, among patients with HIVaged 12-24 years who were on ART and with a viral load > (case) or < (control) than 1000 copies/ml after at least six months on ART. The primary outcome was viral load non-suppression: a plasma viral load > 1000 copies/ ml based on two consecutive viral load measurements every three months. The primary exposure was depressive symptoms as measured using the PHQ-9 (Patient Health Questionnaire, 9-item version). Other variables include adherence to ART and sociodemographic characteristics of participants. Data were collected using structured, blinded lay interviewer-administered questionnaires, and data extraction forms. Conditional multivariable logistic regression was conducted using STATA version 14.2 to test the main hypotheses.
Results: The study enrolled 192 participants, with a median age of 18 years and 52.1% males. None of the participants reported smoking or chewing Khat (a leaf that stimulates mood). With the PHQ-9 tool, 47%, 28%, and 25% had minimal or no, probable to mild and moderate to severe depression symptoms, respectively. Having depressive symptoms is associated with a higher conditional likelihood of virological failure (odds ratio [OR] = 1.8, p < 0.001) and the association was stronger among those who have moderate or severe depressive symptoms (adjusted OR = 5, 95% CI [1.7-14.6] )and unadjusted OR = 6.8, 95% CI [3.1-14.8]). Having moderate and severe depression is associated with non-adherence to ART (adjusted OR = 10.5).
Conclusion: Non-adherence to ART medications, depressive symptoms, advanced WHO stage on ART initiation, poor social support and orphan status were independently associated with virological failure among HIV-infected adolescents and youths on ART. Having moderate and severe depression has higher odds of non-adherence and virological failure. We recommend integration and task-sharing of mental health and HIV care services to reduce virological failure in this group of people.
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