Depression and alcohol use disorder at antiretroviral therapy initiation led to disengagement from care in South Africa

<div><p>We sought to assess mental health at the time of antiretroviral therapy (ART) initiation and subsequent retention in care over a six-month follow-up period. A total of 136 people living with HIV in South Africa were administered surveys measuring demographic information and mental health indicators at the time of ART initiation. Follow-up was completed via chart abstraction to assess for six-month outcomes of retention in care and viral suppression. At enrollment, 45/136 (33%), 67/136 (49%), and 45/136 (33%) participants screened positive for depression, anxiety, and alcohol use disorder, respectively. After six months of follow-up, 96/136 (71%) participants remained in care; 35/87 (40.2%) participants who remained in care had a level <50 copies/mL. Those with depression (49% vs. 77% retained; p < 0.01) and those with alcohol use disorder (52% vs. 76% retained; p < 0.01) were less likely to be retained in care. In multivariable logistic regression, depression OR 3.46 (95% CI: 1.33, 7.97; p < 0.01) and alcohol abuse OR 3.89 (95% CI: 1.70, 8.97; p < 0.01) were independently associated with loss from care. These results emphasize the importance of mental health on early ART outcomes and the HIV care continuum.</p></div

Predictors of disengagement from care—multivariable logistic regression^a (n = 136).

<p>Predictors of disengagement from care—multivariable logistic regression<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0189820#t005fn001" target="_blank">^a</a> (n = 136).</p

Baseline demographics and ocular characteristics.

<p>Baseline demographics and ocular characteristics.</p

Participant characteristics at time of ART initiation.

<p>Participant characteristics at time of ART initiation.</p

Case study of VMT and macular hole.

<p>This 60 year old female patient was diagnosed with right VMT and FTMH (357 microns), she had suffered for 2–3 months with blurred and distorted vision and was very symptomatic, the absence of ERM was confirmed. Vision prior to ocriplasmin injection was R 6/36, L 6/18. The patient was treated with ocriplasmin according to standard MEH protocols and followed up as standard of care. FTMH closed after one week. Vision at Month 7 was 6/24.</p

Visual acuity at 4, 12 and 24 weeks.

<p>Visual acuity at 4, 12 and 24 weeks.</p

Baseline characteristics of individual patients and anatomical resolution of VMT at 4, 12 and 24 weeks.

<p>Baseline characteristics of individual patients and anatomical resolution of VMT at 4, 12 and 24 weeks.</p

Optical coherence tomography scan of vitreomacular traction.

<p>Optical coherence tomography overlapping (x50) line scans are used to exclude ERM.</p

Resolution of vitreomacular traction.

<p>The VMT resolution rates at 4, 12 and 24 weeks following a single intravitreal injection of ocriplasmin (0.125 mg in 0.1ml). VMT was diagnosed by OCT as per the classifications provided by the VMT study group.</p

Anatomical resolution of VMT at 4, 12 and 24 weeks.

<p>Anatomical resolution of VMT at 4, 12 and 24 weeks.</p