Socio-demographic characteristics of study participants
Four hundred forty-two HIV-positive patients participated in the study, and the response rate was 100%. The patients’ mean (SD) age was 42.8(10.7) years. More than half, 64.0% (n=269) of the patients were females. The majority (88.1%) (n=370) were urban residents. Nearly one-third, 36.4% (n=153) of the study participants attended primary school. About half, 48.1% (n=202) of the participants were married. Among the study subjects, 46.9% (n=197) of PLHA were unemployed. Nearly half of the participants, 51.9% (n=218), had an average monthly income of 1001-5000 Ethiopian Birr (Table 1).
Table 1: Socio-demographic characteristics of patients taking ART in Adama hospital medical college, 2021.
Variables (n=420)
|
Frequency
|
Percent
|
Age of the patients (Years)
|
|
|
18-24
|
25
|
6.0
|
25-34
|
49
|
11.7
|
35-44
|
162
|
38.6
|
≥45
|
184
|
43.8
|
Sex of the patients
|
|
|
Male
|
151
|
36.0
|
Female
|
269
|
64.0
|
Residence
|
|
|
Urban
|
370
|
88.1
|
Rural
|
50
|
11.9
|
Educational status of the patients
|
|
|
No formal education
|
88
|
21.0
|
Primary education
|
153
|
36.4
|
Secondary education
|
123
|
29.3
|
Tertiary education
|
56
|
13.3
|
Marital status
|
|
|
Married
|
202
|
48.1
|
Divorce/Separated
|
77
|
18.3
|
Single
|
47
|
11.2
|
Widowed
|
87
|
20.7
|
Separate
|
7
|
1.7
|
Ethnic group
|
|
|
Amhara
|
199
|
47.4
|
Oromo
|
159
|
37.9
|
Tigray
|
16
|
3.8
|
Gurage
|
34
|
8.1
|
Others
|
12
|
2.9
|
Religion
|
|
|
Orthodox
|
299
|
71.2
|
Protestant
|
64
|
15.2
|
Muslim
|
56
|
13.3
|
Others
|
1
|
0.2
|
Work status
|
|
|
Employed
|
223
|
53.1
|
Unemployed
|
197
|
46.9
|
Income (ETB)
|
|
|
<1000
|
183
|
43.6
|
1001-5000
|
218
|
51.9
|
≥5001
|
19
|
4.5
|
Psychological and social characteristics of HIV-positive patients
Only (10%) (n=42) and 2.9 %( n=9) of the study participants consumed alcohol and chew chat, respectively. Almost all 99.5 %( n=418) patients were non-smokers. Twenty-five (6.0%) of the study participants had a past psychiatric history. Nearly one-fifth (19%) (n=90) of HIV-positive patients have co-morbid psychiatric conditions, while 2.9 % (n=12) were taking antidepressants. Among the study participants, 7.6% (n=32) replied that they had poor social support. The majority, 86.4 %( n=363), had no impairments in activities of daily living(Table 2).
Table 2: Psychological and social characteristics of patients taking ART in Adama hospital medical college, 2021.
Variables (n=420)
|
Frequency
|
Percent
|
Alcohol consumption
|
|
|
Yes
|
42
|
10.0
|
No
|
378
|
90.0
|
Chewing Chat
|
|
|
Yes
|
12
|
2.9
|
No
|
408
|
97.1
|
Smoking Cigarettes
|
|
|
Yes
|
2
|
0.5
|
No
|
418
|
99.5
|
Past psychiatric history
|
|
|
Yes
|
25
|
6.0
|
No
|
395
|
94.0
|
Co-morbid psychiatric condition
|
|
|
Yes
|
80
|
19.0
|
No
|
340
|
81.0
|
Taking antidepressants
|
|
|
Yes
|
12
|
2.9
|
No
|
408
|
97.1
|
Family history of psychiatric illness
|
|
|
Yes
|
25
|
6.0
|
No
|
395
|
94.0
|
Poor social support
|
|
|
Yes
|
32
|
7.6
|
No
|
388
|
92.4
|
Living companion
|
|
|
Yes
|
357
|
85.0
|
No
|
63
|
15.0
|
Sources of financial support
|
|
|
Self
|
307
|
73.1
|
Other sources
|
113
|
26.9
|
Impairment in activities of daily living
|
|
|
Yes
|
57
|
13.6
|
No
|
363
|
86.4
|
Chronic Non-communicable diseases among PLHA
Among HIV-positive patients, 8.6% (n=36) had diabetes mellitus. Thirty-three participants (7.9%) had hypertension, and 2.6% (n=11) had cardiac problems. One in ten, 10.5% (n=44) of the study participants had a history of Asthma attacks. 27.9% (n=117) of the survey participants had at least one chronic non-communicable disease (Table 3).
Table 3: Presence of chronic Non-communicable diseases among patients taking ART in Adama hospital medical college, 2021.
Variables (n=420)
|
Frequency
|
Percent
|
Diabetes
|
|
|
Yes
|
36
|
8.6
|
No
|
384
|
91.4
|
Hypertension
|
|
|
Yes
|
33
|
7.9
|
No
|
387
|
92.1
|
Cardiac diseases
|
|
|
Yes
|
11
|
2.6
|
No
|
409
|
97.4
|
Asthma
|
|
|
Yes
|
44
|
10.5
|
No
|
376
|
89.5
|
Chronic non-communicable diseases
|
|
|
Yes
|
117
|
27.9
|
No
|
303
|
72.1
|
Health and Nutrition related conditions of HIV-positive patients
Nearly half, 51.7% (n=217) of the study participants were concordant positive and one-third, 33.3% (n=140) of the HIV-positive patients don’t know their partner’s HIV status. Regarding viral suppression, 95.5% (n=401) of the participants had a viral load of <1000 copies/mm3. Nearly two-thirds, 63.8 % (n=268) of the patients presented with CD4 <200 cells/mm3 at diagnosis. Regarding the most recent CD4, 37.9% (n= 159) of the study participants had ≥500 cells/mm3. The majority, 79.5% (n=334) of the HIV-positive patients, were in the stage 1 WHO clinical stage. Nearly one-third, 36.9% (n=155)of HIV-positive patients had ever developed an opportunistic infection. The majority, 91.7% (n=385) and 72.4 %(n=304) of the participants were on first-line treatment and had normal BMI, respectively (Table 4).
Table 4: Health and Nutrition related conditions of patients taking ART in Adama hospital medical college, 2021.
Variables (n=420)
|
Frequency
|
Percent
|
Partner HIV status
|
|
|
Positive
|
217
|
51.7
|
Negative
|
63
|
15.0
|
Unknown
|
140
|
33.3
|
Viral load
|
|
|
≥1000 copies/mm3
|
19
|
4.5
|
<1000 copies/mm3
|
401
|
95.5
|
CD4 at diagnosis
|
|
|
<200 cells/mm3
|
268
|
63.8
|
200-499 cells/mm3
|
126
|
30.0
|
≥500 cells/mm3
|
26
|
6.2
|
Most recent CD4 count
|
|
|
<200 cells/mm3
|
67
|
16.0
|
200-499 cells/mm3
|
194
|
46.1
|
≥500 cells/mm3
|
159
|
37.9
|
WHO clinical stage
|
|
|
Stage 1
|
334
|
79.5
|
Stage 2
|
41
|
9.8
|
Stage 3
|
33
|
7.9
|
Stage 4
|
12
|
2.9
|
Ever developed opportunistic infection
|
|
|
Yes
|
155
|
36.9
|
No
|
265
|
63.1
|
Treatment level
|
|
|
First line
|
385
|
91.7
|
Second line
|
35
|
8.3
|
ART dose is given per day
|
|
|
Once daily
|
371
|
88.3
|
Twice daily
|
48
|
10.2
|
Three times daily
|
6
|
1.4
|
Months on ART
|
|
|
≤24 months
|
76
|
18.1
|
>24 months
|
344
|
81.9
|
Any side effects of ART medication
|
|
|
Yes
|
44
|
10.5
|
No
|
376
|
89.5
|
Currently taking any treatment other than ART
|
|
|
Yes
|
41
|
9.8
|
No
|
379
|
90.2
|
Adherence to ART medication
|
|
|
Adhered
|
400
|
95.2
|
Not adhered
|
20
|
4.8
|
HIV disclosure status
|
|
|
Disclosed
|
310
|
73.8
|
Not disclosed
|
110
|
26.2
|
Felt stigmatization
|
|
|
Yes
|
132
|
31.4
|
No
|
228
|
68.6
|
Daily eating pattern
|
|
|
Three meals or more
|
368
|
87.6
|
Two meals or less
|
52
|
12.4
|
BMI
|
|
|
Underweight
|
45
|
10.7
|
Normal
|
304
|
72.4
|
Overweight
|
71
|
16.9
|
Depression among HIV Positive patients
Based on the PHQ9 depression severity assessment scale, 33.3% (n=140) of the study participants have minimal depression, while 9 (2.1%) have severe depression (Figure 1).
The prevalence of depression among patients taking ART in Adama Hospital Medical College was 52.4% (95% CI= 47.6-57.1) (Figure 2).
Factors associated with depression among HIV-positive patients
The simple logistic regression analysis revealed that depression among HIV-positive patients had an association with the educational level of the patients, work status, chewing chat, family history of psychiatric illness, patient’s most recent CD4 count, months on ART and chronic non-communicable diseases. Those variables with a p-value of less than 0.25 in the simple logistic regression analysis were entered in multiple logistic regression analysis. A standard logistic regression model-building method was employed. In multiple logistic regression analysis, work status, patient’s most recent CD4 count, months on ART and chronic non-communicable diseases were significantly associated with depressive symptoms among HIV-positive patients.
The odds of employed patients having depressive symptoms were 78% [AOR=0.22(95% CI= 0.13-0.36)] lesser than unemployed patients. HIV-positive patients who had the most recent CD4 count <200 cells/mm3 were seven times [AOR=6.99 (95%CI=2.81-17.38)] more likely to have depression than patients with CD4 count ≥500 cells/mm3. Patients who received ART for ≤24 months were five times [AOR=5.05 (2.38-10.74)] more likely to have depression than their counterparts. HIV-positive patients with co-morbid chronic non-communicable disease were eight times [AOR=7.90 (4.21-14.85)] more likely to have depression than their counterparts (Table 5).
Table 5: Determinants of depression among HIV-positive patients in Adama Hospital Medical College, 2021.
Variables (n=420)
|
Depression
|
COR
(95% CI)
|
|
Yes
n= 220 (%)
|
No
n= 200 (%)
|
AOR (95% CI)
|
Level of education
|
|
|
|
|
No formal education
|
50
|
38
|
2.19(1.10-4.35)
|
1.45(0.59-3.54)
|
Primary education
|
84
|
69
|
2.02(1.08-3.80)
|
1.83(0.81-4.14)
|
Secondary education
|
65
|
58
|
1.87(0.98-3.56)
|
1.46(0.63-3.36)
|
Tertiary education
|
21
|
35
|
1
|
1
|
Work status
|
|
|
|
|
Employed
|
84
|
139
|
0.27(0.18-0.41)
|
0.22(0.13-0.36)**
|
Unemployed
|
136
|
61
|
1
|
1
|
Chat chewing
|
|
|
|
|
Yes
|
11
|
1
|
10.47(1.34-81.87)
|
6.82(0.69-67.23)
|
No
|
209
|
199
|
1
|
1
|
Family history of psychiatric illness
|
|
|
|
|
Yes
|
20
|
5
|
3.90(1.43-10.59)
|
3.04(0.92-10.06)
|
No
|
200
|
195
|
1
|
|
Most recent CD4 count
|
|
|
|
|
<200 cells/mm3
|
59
|
8
|
9.14(4.09-20.38)
|
6.99(2.81-17.38)*
|
200-499 cells/mm3
|
90
|
104
|
1.10(0.70-1.63)
|
1.03(0.62-1.71)
|
≥500 cells/mm3
|
71
|
88
|
1
|
1
|
Months on ART
|
|
|
|
|
≤24 months
|
64
|
12
|
6.43(3.35-12.34)
|
5.05(2.38-10.74)**
|
>24 months
|
156
|
188
|
1
|
1
|
Chronic Non-communicable diseases
|
|
|
|
|
Yes
|
99
|
18
|
8.27(4.76-14.37)
|
7.90(4.21-14.85)**
|
No
|
121
|
182
|
1
|
1
|
NB: 1- Reference group, *= P<0.05, **= P<0.0