Depression, alcohol use and adherence to antiretroviral therapy in sub-saharan Africa: a systematic review.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Hampton House, Baltimore, MD, 21205, USA, .
AIDS and Behavior (Impact Factor: 3.49). 11/2011; 16(8):2101-18. DOI: 10.1007/s10461-011-0087-8
Source: PubMed

ABSTRACT This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5-38.2%, Tau(2) = 0.23) and 18% (95% CI 12.3-25.8%, Tau(2) = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31-0.66, Tau(2) = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.