RESEARCH PAPER
Mood and anxiety disorders adversely influence medication adherence to antiretroviral therapy among people living with HIV/AIDS in Nigeria
Submission date: 2017-06-22
Final revision date: 2018-01-14
Acceptance date: 2018-01-16
Publication date: 2018-05-21
HIV & AIDS Review 2018;17(2):91-97
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Psychological disorders in HIV/AIDS are well documented. However, studies enumerating its impact on medication adherence are scanty in developing countries. This study sought to determine the collective impact of mood and anxiety disorders on medication adherence among persons living with HIV/AIDS (PLWHA), receiving care at a secondary health care facility in Benin-City, Nigeria.
Material and methods:
A cross-sectional descriptive study of 410 PLWHA was conducted between April and August 2015. A semi-structured socio-demographic and clinical history study questionnaire, the 8-item Morisky medication adherence scale (MMAS-8) to determine medication adherence to highly active antiretroviral therapy (HAART), and the mini international neuropsychiatric interview (MINI) to diagnose mood and anxiety disorders were administered to participants.
Results:
One hundred and fifty-one participants (36.8%) were poorly adherent to their medications, with nearly 1 in 3 (31.5%) diagnosed with a mood or anxiety disorder. On bivariate analysis, poor medication adherence was significantly associated with low (< 200 cell/mm3) CD4 cell count (crude OR = 3.23; 95% CI: 1.81-5.80; p < 0.001) and having a mood or anxiety disorder (crude OR = 17.89; 95% CI: 10.28-31.38; p < 0.001). The presence of a mood/anxiety disorder predicted poor adherence (AOR = 16.45; 95% CI: 9.69-27.92; p < 0.001) on multivariate analysis.
Conclusions:
Mood and anxiety disorders in PLWHA are common and are associated with poorer medication adherence. Further research is required to assess if screening and management of mood and anxiety disorders would improve medication adherence.
Psychological disorders in HIV/AIDS are well documented. However, studies enumerating its impact on medication adherence are scanty in developing countries. This study sought to determine the collective impact of mood and anxiety disorders on medication adherence among persons living with HIV/AIDS (PLWHA), receiving care at a secondary health care facility in Benin-City, Nigeria.
Material and methods:
A cross-sectional descriptive study of 410 PLWHA was conducted between April and August 2015. A semi-structured socio-demographic and clinical history study questionnaire, the 8-item Morisky medication adherence scale (MMAS-8) to determine medication adherence to highly active antiretroviral therapy (HAART), and the mini international neuropsychiatric interview (MINI) to diagnose mood and anxiety disorders were administered to participants.
Results:
One hundred and fifty-one participants (36.8%) were poorly adherent to their medications, with nearly 1 in 3 (31.5%) diagnosed with a mood or anxiety disorder. On bivariate analysis, poor medication adherence was significantly associated with low (< 200 cell/mm3) CD4 cell count (crude OR = 3.23; 95% CI: 1.81-5.80; p < 0.001) and having a mood or anxiety disorder (crude OR = 17.89; 95% CI: 10.28-31.38; p < 0.001). The presence of a mood/anxiety disorder predicted poor adherence (AOR = 16.45; 95% CI: 9.69-27.92; p < 0.001) on multivariate analysis.
Conclusions:
Mood and anxiety disorders in PLWHA are common and are associated with poorer medication adherence. Further research is required to assess if screening and management of mood and anxiety disorders would improve medication adherence.
REFERENCES (47)
1.
Joint United Nations Program on HIV/AIDS. UNAIDS report on the global AIDS epidemic, 2013.
2.
Federal Ministry of Health [Nigeria]. National HIV & AIDS and Reproductive Health Survey, 2012 (NARHS Plus). Fmoh, Abuja 2013.
3.
National Population Commission. Population and housing census of the Federal Republic of Nigeria, 2006.
4.
Brandt R. The mental health of people living with HIV/AIDS in Africa: a systematic review. Afr J AIDS Res 2009; 8: 123-133.
5.
Els C, Boshoff W, Scott C, et al. Psychiatric co-morbidity in South African HIV/AIDS patients. South African Med J 1999; 89: 992-995.
6.
Freeman M, Nkomo N, Kafaar Z, Kelly K. Mental disorder in people living with HIV/AIDS in South Africa. South African J Psychol 2008; 38: 489-500.
7.
Chikezie UE, Otakpor AN, Kuteyi OB, James BO. Depression among people living with human immunodeficiency virus infection/acquired immunodeficiency syndrome in Benin City, Nigeria: a comparative study. Niger J Clin Pract 2013; 16: 238-242.
8.
Adewuya AO, Afolabi MO, Ola BA, et al. Psychiatric disorders among the HIV-positive population in Nigeria: a control study. J Psychosom Res 2007; 63: 203-206.
9.
Sebit MB, Tombe M, Siziya S, et al. Prevalence of HIV/AIDS and psychiatric disorders and their related risk factors among adults in Epworth, Zimbabwe. East Afr Med J 2003; 80: 503-512.
10.
Sulyman D, Abiodun OA, Yussuf AD. Psychiatric disorders among People Living with HIV/AIDS attending out-patient clinics at University of Ilorin Teaching Hospital, Nigeria. Trop J Heal Sci 2012; 19: 12-17.
11.
Olley BO, Gxamza F, Seedat S, et al. Psychopathology and coping in recently diagnosed HIV/AIDS patients – the role of gender. South African J Psychol 2004; 10: 21-24.
12.
Nebhinani N, Mattoo SK, Wanchu A. HIV stigma and specified correlates in North India. Indian J Psychol Med 2012; 34: 324-331.
13.
Nel A, Kagee A. The relationship between depression, anxiety and medication adherence among patients receiving antiretroviral treatment in South Africa. AIDS Care 2013; 25: 948-955.
14.
Adewuya AO, Afolabi MO, Ola BA, et al. Relationship between depression and quality of life in persons with HIV infection in Nigeria. Int J Psychiatry Med 2008; 38: 43-51.
15.
Ogbuji QC, Oke AE. Quality of life among persons living with HIV infection in Ibadan, Nigeria. Afr J Med Med Sci 2010; 39: 127-135.
16.
Arnsten J, Demas P, Farzadegan H, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis 2001; 33: 1417-1423.
17.
Gifford A, Bormann J, Shively M, et al. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. J Acquir Immune Defic Syndr 2000; 23: 386-395.
18.
Adewuya AO, Afolabi MO, Ola BA, et al. The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria. Psychosomatics 2010; 51: 68-73.
19.
Sternhell PS, Corr MJ. Psychiatric morbidity and adherence to antiretroviral medication in patients with HIV/AIDS. Aust N Z J Psychiatry 2002; 36: 528-533.
20.
Vranceanu AM, Safren SA, Lu M, et al. The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV. AIDS Patient Care STDS 2008; 22: 313-322.
21.
Amberbir A, Woldemichael K, Getachew S, et al. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia. BMC Public Health 2008; 8: 265.
22.
Olisah VO, Baiyewu O, Sheikh TL. Adherence to highly active anti retroviral therapy in depressed patients with HIV/AIDS attending a Nigerian university teaching hospital clinic. Afr J Psychiatry (Johannesbg) 2010; 13: 275-279.
23.
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 Suppl 20: 22-33.
24.
Adewuya AO, Ola BA, Aloba OO, et al. Alcohol use disorders among Nigerian university students: Prevalence and socio-demographic correlates. Niger J Psychiatry 2007; 5: 5-9.
25.
Sulyman D, Abiodun OA, Yussuf AD. Detection of psychiatric disorders by physicians attending to People Living with HIV/AIDS (PLWHA) in a Nigeria University Teaching Hospital. J Biol Agric Healthcare 2013; 3: 92-97.
26.
Morisky D, Ang A, Krousel-Wood M, Ward H. Predictive Validity of a Medication Adherence Measure in an Out-patient Setting. J Clin Hypertens (Greenwich) 2008; 10: 348-354.
27.
Adelufosi AO, Adebowale TO, Abayomi O, Mosanya JT. Medication adherence and quality of life among Nigerian outpatients with schizophrenia. Gen Hosp Psychiatry 2002; 34: 72-79.
28.
Mahaye S, Mayime T, Nkosi S, et al. Medication adherence of psychiatric patients in an outpatient setting. African J Pharm Pharmacol 2012; 6: 608-612.
29.
Gureje O, Lasebikan V, Kola L, et al. Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. Br J Psychiatry 2006; 188: 465-471.
30.
Nakimuli-Mpungu E, Bass JK, Alexandre P, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-saharan africa: a systematic review. AIDS Behav 2012; 16: 2101-2118.
31.
Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. J Am Med Assoc 2011; 285: 1466-1474.
32.
Herbert T, Cohen S. Depression and immunity: a meta-analytic review. Psychol Bull 1993; 113: 472-486.
33.
Olley BO, Seedat S, Nei DG, Stein DJ. Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDS 2004; 18: 481-487.
34.
Kaharuza FM, Bunnell R, Moss S, et al. Depression and CD4 cell count among persons with HIV infection in Uganda. AIDS Behav 2006; 10 (Suppl 4): 105-111.
35.
Gaynes BN, O’Donnell J, Nelson E, et al. Psychiatric comorbidity in depressed HIV-infected individuals: common and clinically consequential. Gen Hosp Psychiatry 2015; 37: 277-282.
36.
Turner BJ, Fleishman JA. Effect of dysthymia on receipt of HAART by minority HIV-infected women. J Gen Intern Med 2006; 21: 1235-1241.
37.
de Sousa Gurgel W, da Silva Carneiro AH, Barreto Rebouças D, et al. Prevalence of bipolar disorder in a HIV-infected outpatient population. AIDS Care 2013; 25: 1499-1503.
38.
Olagunju AT, Ogundipe OA, Erinfolami AR, et al. Toward the integration of comprehensive mental health services in HIV care: an assessment of psychiatric morbidity among HIV-positive individuals in sub-Saharan Africa. AIDS Care 2013; 25: 1193-1198.
39.
Obiako OR, Muktar HM. Challenges of HIV treatment in resource-poor countries: a review. Niger J Med 2010; 19: 361-368.
40.
Ammassari A, Antinori A, Aloisi MS, et al. Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics 2004; 45: 394-402.
41.
Abrogoua DP, Kablan BJ, Kamenan BAT, et al. Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings. Patient Prefer Adherence 2012; 6: 227-237.
42.
Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 2006; 10: 473-482.
43.
World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, 2013.
44.
Chesney M. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis 2000; 30 (Suppl 2): S171-S176.
45.
Marcellin F, Spire B, Carrieri MP, Roux P. Assessing adherence to antiretroviral therapy in randomized HIV clinical trials: a review of currently used methods. Expert Rev Anti Infect Ther 2013; 11: 239-250.
46.
Bolsewicz K, Debattista J, Vallely A, et al. Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom. AIDS Care 2015; 27: 1429-1438.
47.
Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments. AIDS Care 2000; 12: 255-266.
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