Literature DB >> 32128556

PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to Care.

Christina Psaros1, Jennifer A Smit2,3, Nzwakie Mosery2, Kara Bennett4, Jessica N Coleman5,6, David R Bangsberg7, Steven A Safren8.   

Abstract

BACKGROUND: Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support.
PURPOSE: To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development.
METHODS: We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence.
RESULTS: Elevated depressive symptoms were directly associated with significantly lower adherence (est = -8.60, 95% confidence interval [-15.02, -2.18], p < .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p < .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p < .01). Structural barriers, defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence.
CONCLUSIONS: Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support. © Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Entities:  

Keywords:  Adherence; Depression; HIV; Pregnancy; Social support; Stigma; Structural barriers; Vertical transmission

Mesh：

Substances：

Year:  2020        PMID： 32128556      PMCID： PMC7459185          DOI： 10.1093/abm/kaaa005

Source DB:  PubMed          Journal:  Ann Behav Med        ISSN： 0883-6612


  65 in total

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Journal:  AIDS Behav       Date:  2016-09

Review 2.  Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis.

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3.  Prospective Study of the Mental Health Consequences of Sexual Violence Among Women Living With HIV in Rural Uganda.

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Review 4.  Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature.

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Journal:  J Matern Fetal Neonatal Med       Date:  2007-03

5.  Time in the United States, social support and health behaviors during pregnancy among women of Mexican descent.

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Journal:  Soc Sci Med       Date:  2006-01-05       Impact factor: 4.634

6.  Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda.

Authors:  Alexander C Tsai; David R Bangsberg; Edward A Frongillo; Peter W Hunt; Conrad Muzoora; Jeffrey N Martin; Sheri D Weiser
Journal:  Soc Sci Med       Date:  2012-03-23       Impact factor: 4.634

7.  Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa.

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8.  Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale.

Authors:  Seth C Kalichman; Leickness C Simbayi; Allanise Cloete; Phumelele P Mthembu; Ruth N Mkhonta; Themba Ginindza
Journal:  AIDS Care       Date:  2009-01

9.  Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study.

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Journal:  AIDS Care       Date:  2008-11

Review 10.  Identifying the women at risk of antenatal anxiety and depression: A systematic review.

Authors:  Alessandra Biaggi; Susan Conroy; Susan Pawlby; Carmine M Pariante
Journal:  J Affect Disord       Date:  2015-11-18       Impact factor: 4.839
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  8 in total

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Journal:  AIDS Behav       Date:  2022-10-09

2.  Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial.

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Journal:  Int J Behav Med       Date:  2022-03-08

3.  Food insecurity, drug resistance and non-disclosure are associated with virologic non-suppression among HIV pregnant women on antiretroviral treatment.

Authors:  Bhavna H Chohan; Keshet Ronen; Brian Khasimwa; Daniel Matemo; Lusi Osborn; Jennifer A Unger; Alison L Drake; Ingrid A Beck; Lisa M Frenkel; John Kinuthia; Grace John-Stewart
Journal:  PLoS One       Date:  2021-08-18       Impact factor: 3.240

4.  What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.

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5.  An evaluation of a combined psychological and parenting intervention for HIV-positive women depressed in the perinatal period, to enhance child development and reduce maternal depression: study protocol for the Insika Yomama cluster randomised controlled trial.

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6.  Factors Affecting Antiretroviral Therapy Adherence among HIV-Positive Pregnant Women in Greece: An Exploratory Study.

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7.  Perinatal Depressive Symptoms, Human Immunodeficiency Virus (HIV) Suppression, and the Underlying Role of Antiretroviral Therapy Adherence: A Longitudinal Mediation Analysis in the IMPAACT P1025 Cohort.

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8.  Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder.

Authors:  Kathryn J Roberts; Colette Smith; Lucie Cluver; Elona Toska; Siyanai Zhou; Mark Boyes; Lorraine Sherr
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  8 in total

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