PROBABLE PERINATAL DEPRESSION, ENGAGEMENT IN HIV CARE, AND VIRAL SUPPRESSION AMONG MALAWIAN WOMEN Public Deposited

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  • March 21, 2019
Creator
  • Harrington, Bryna
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • With broadened antiretroviral treatment (ART) eligibility, long-term HIV care engagement has been sub-optimal. Care engagement may be hindered by antenatal depression, yet depression screening is not routine in most African countries. We estimated factors associated with antenatal depression, the prevalence and incidence of perinatal depression, and the relationship of antenatal depression with HIV care engagement among a cohort study of pregnant women living with HIV (n=725) recruited from a government antenatal clinic in Malawi in 2015-2016. Depression was assessed at enrollment and four times postpartum with the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9). Participants’ median age was 29 years, and at enrollment had a median 22 weeks gestation. Most were married (90%) and their current pregnancy was unintended (68%). Many women reported a history of depression or anxiety: 46% had a personal history and 20% had a family history; 17% reported experiencing intimate partner violence (IPV). Women were more likely to have probable antenatal depression if they reported a history of depression (adjusted prevalence ratio 2.42; 95%CI 1.48-3.95), IPV (1.77; 1.11-2.81), had an unintended current pregnancy (1.78; 0.99-3.21), were unmarried (1.66; 0.97-2.84), or were employed (1.56; 1.00-2.44). Among women initiating ART (n=299), 10% had probable antenatal depression, yet only 2-5% postpartum. Sensitivity analyses to account for loss to follow up suggested that postpartum depression prevalence could have ranged from 2-11%. EPDS and PHQ-9 scores were concordant for 95% of assessments. Most women were engaged in care through 12 months post-ART initiation: 85% attended all scheduled visits, and 81% were in care and virally suppressed. For both care engagement outcomes, there were no differences by antenatal depression status (visit attendance risk difference: -0.02; 95%CI -0.16-0.12; adjusted: -0.04; 95%CI -0.18-0.10) (viral suppression prevalence difference: -0.02; 95%CI -0.17-0.13; adjusted: -0.01; 95%CI -0.17-0.15). Probable perinatal depression was more common antenatally than postpartum among women with HIV in Malawi. Factors associated with probable antenatal depression represented heightened psychosocial stress. Women with and without antenatal depression were equally likely to remain engaged in care postpartum. Programs should consider screening and support services for psychosocial factors to facilitate women’s sustained HIV care engagement.
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Advisor
  • Hosseinipour, Mina
  • Miller, William
  • Gaynes, Bradley
  • Pence, Brian
  • Maselko, Joanna
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2018
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