Prevalence of Depression and Its Relationship to Care Engagement among Men Living with HIV

Background: The study was focused on the prevalence of depression among men living with HIV, who are in HIV care, and assessed the relationship between depression and care engagement. Several factors have been associated with care engagement among people living with HIV, including depression, but also lack disclosure due to stigmatization, poor social support, high pill burden, poor knowledge of ART, as well as young or old age. However, little is known about how these risk factors play out in men, as most of literature have been directed on women. Objectives: To understand the prevalence of depression in men living with HIV, attending Mawenzi Care and Treatment Clinic, and the effect of depression on care engagement. Method: A cross-sectional survey was conducted in the Mawenzi CTClinic, in Moshi, Kilimanjaro, Tanzania. Adult men living with HIV, 18 years and above, were invited to participate. A composite, continuous scale was developed to measure care engagement. At the clinic participants were asked about their medication adherence, their clinic cards were also checked for their viral load. Self-reported medication adherence and viral load were combined to form the outcome variable or as an indicator of patient care engagement. A total of 203 participants were enrolled in the study, with a mean age of 48 years. Results: The prevalence of depression among men living with HIV was 47.8 %: 35.0 % had mild symptoms, 8.9% moderate symptoms, and 3.9% severe symptoms. There was an indirect relationship between predictors: stigma was associated with depression and depression was associated with care engagement. Conclusion: HIV-related stigma and depression should not be underestimated because of their association with each other. Symptoms of depression need to be treated early, to reduce their effects on care engagement and hence disease progression

"At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania.

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment

"At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania.

IntroductionDespite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services.MethodsWe conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis.ResultsWe observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement.ConclusionIn order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment