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Changes in ART Adherence Relate to Changes in depression as Well! Evidence for the Bi-directional Longitudinal Relationship Between Depression and ART Adherence from a Prospective Study of HIV Clients in Uganda.

ABSTRACT: Studies have documented how levels and change in depression correspond to ART non-adherence. However, few studies have examined how levels of and change in adherence may relate to levels of and change in depression, although one might expect mental health to be related to physical health and how successful one is in managing disease. To assess the bidirectional nature of the association between these two constructs, we examined data from a prospective trial of an ART adherence intervention in Uganda that followed 143 participants over 20 months. Adherence was measured using electronic monitoring caps; non-adherence was defined as missing > 10% of prescribed doses; self-reported depression was measured using the Patient Health Questionnaire (PHQ-9), and PHQ-9 > 4 defined the presence of at least minor depression. Adjusted linear and logistic regression models were used to examine the longitudinal relationships between depression and non-adherence. At baseline, 40.6% had at least minor depression and 37.1% were non-adherent. Time varying change in the classification of depression (e.g., becoming depressed) predicted change in non-adherence status (e.g., becoming non-adherent), and this association remained when examining continuous measures of the constructs. Similarly, time varying measures of increases in non-adherence predicted increases in depression, regardless of whether continuous or binary classification measures were used. A temporal trend of increased non-adherence over time was observed, and this was accelerated by an increase in depression. Furthermore, those who had at least minor depression at baseline were more likely to be non-adherent at follow-up. These findings support the potential benefits of depression care and adherence support for improving adherence and mental health, respectively, and call for further research to examine such benefits.The trial has been registered with ClinicalTrials.gov (NCT02503072).

SUBMITTER: Wagner GJ

PROVIDER: S-EPMC7228829 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The current dogma to explain the extent of injury-related changes following rodent controlled cortical impact (CCI) injury is a focal injury with limited axonal pathology. However, there is in fact good, published histologic evidence to suggest that axonal injury is far more widespread in this model than generally thought. One possibility that might help to explain this is the often-used region-of-interest data analysis approach taken by experimental traumatic brain injury (TBI) diffusion tensor imaging (DTI) or histologic studies that might miss more widespread damage, when compared to the whole brain, statistically robust method of tract-based analysis used more routinely in clinical research. To determine the extent of DTI changes in this model, we acquired in vivo DTI data before and at 1 and 4weeks after CCI injury in 17 adult male rats and analyzed parametric maps of fractional anisotropy (FA), axial, radial, and mean diffusivity (AD, RD, MD), tensor mode (MO), and fiber tract density (FTD) using tract-based spatial statistics. Contusion volume was used as a surrogate marker of injury severity and as a covariate for investigating severity dependence of the data. Mean fiber tract length was also computed from seeds in the cortical spinal tract regions. In parallel experiments (n=3-5/group), we investigated corpus callosum neurofilaments and demyelination using immunohistochemistry (IHC) at 3days and 6weeks, callosal tract patency using dual-label retrograde tract tracing at 5weeks, and the contribution of gliosis to DTI parameter maps using GFAP IHC at 4weeks post-injury. The data show widespread ipsilateral regions of significantly reduced FA at 1week post-injury, driven by temporally changing values of AD, RD, and MD that persist to 4weeks. Demyelination, retrograde label tract loss, and reductions in MO (tract degeneration) and FTD were shown to underpin these data. Significant FA increases occurred in subcortical and corticospinal tract regions that were spatially distinct from regions of FA decrease, grossly affected gliotic areas, and MO changes. However, there was good spatial correspondence between regions of increased FA and areas of increased FTD and mean fiber length. We discuss these widespread changes in DTI parameters in terms of axonal degeneration and potential reorganization, with reference to a resting state fMRI companion paper (Harris et al., 2016, Exp. Neurol. 227:124-138) that demonstrated altered functional connectivity data acquired from the same rats used in this study.

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Project description:Background:depression is common among people living with HIV, but rarely diagnosed and treated in sub-Saharan Africa, in part due to the paucity of mental health professionals. Task-shifting approaches have been used to address this barrier. We compared the effects of two task-shifting models of depression care on depression alleviation and antidepressant response. Methods:we conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by trained medical providers, one that utilized a structured protocol (protocolized) and one that relied on the judgment of trained providers (clinical acumen), in 10 HIV clinics in Uganda. A sample of 1252 clients (640 at protocolized clinics, 612 at clinical acumen clinics) who had screened positive for potential depression on the 2-item Patient Health Questionnaire (PHQ-2) were enrolled and followed for 12 months. Interviewer-administered 9-item PHQ (PHQ-9) data from the research surveys, and provider administrations to clients treated with antidepressant therapy, were examined. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering. Results:among the whole sample (regardless of treatment status), rates of depression alleviation (PHQ-9<5) at month 12 were equivalent in the protocolized (75%) and clinical acumen (77%) arms, in an intention-to-treat analysis. Similarly, among the 415 participants who received antidepressant care, rates of treatment response (PHQ-9<5) at the last provider administered PHQ-9 (average of 8 months into treatment) were equivalent between the protocolized (65%) and clinical acumen (69%) arms; rate of improvement over the course of treatment was also equivalent. Conclusions:nurses can provide quality depression care to HIV clients, regardless of whether treatment is guided by a structured protocol or clinical acumen, in the context of appropriate training and ongoing supervision support.

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Changes in ART Adherence Relate to Changes in depression as Well! Evidence for the Bi-directional Longitudinal Relationship Between Depression and ART Adherence from a Prospective Study of HIV Clients in Uganda.

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