@article{discovery10054669,
          number = {2},
           month = {June},
            year = {2018},
         journal = {Journal of Acquired Immune Deficiency Syndromes (JAIDS)},
           pages = {136--143},
           title = {Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda},
          volume = {78},
            note = {This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where
it is permissible to download, share, remix, transform, and buildup the
work provided it is properly cited. The work cannot be used commercially
without permission from the journal.},
            issn = {1525-4135},
        abstract = {Background: There is still wide variability in HIV disease course and other HIV-related outcomes, attributable in part to psychosocial factors such as major depressive disorder (MDD), a subject that has received little attention in sub-Saharan Africa.

Methods: Using a longitudinal cohort of 1099 HIV-positive antiretroviral therapy-naive persons, we investigated the impact of MDD on 4 HIV-related negative outcome domains in Uganda. MDD was assessed using a Diagnostic Statistical Manual IV-based tool. Also collected were data on surrogate measures of the HIV-related outcome domains. Data were collected at the 3 time points of baseline, 6, and 12 months. Multiple regression and discrete time survival models were used to investigate the relationship between MDD and indices of the HIV outcomes.

Results: MDD was a significant predictor of "missed antiretroviral therapy doses" [adjusted odds ratio (aOR) = 4.75, 95\% confidence interval (CI): 1.87 to 12.04, P = 0.001], "time to first visit to healthy facility" (aOR = 1.71; 95\% CI: 1.07 to 2.73; P = 0.024), "time to first self-reported risky sexual activity" (aOR = 2.11, 95\% CI: 1.27 to 3.49; P = 0.004) but not of "CD4 counts at months 6 and 12" (estimated effect 29.0; 95\% CI: ?7.8 to 65.7; P = 0.12), and "time to new WHO stage 3 or 4 clinical event" (aOR = 0.52, 95\% CI: 0.12 to 2.20, P = 0.37).

Conclusions: MDD significantly impacted 3 of the 4 investigated outcome domains. These results by demonstrating the adverse consequences of an untreated mental health disorder (MDD) on HIV-related outcomes further strengthen the need to urgently act on WHO's call to integrate mental health care in general HIV care.},
          author = {Kinyanda, E and Levin, J and Nakasujja, N and Birabwa, H and Nakku, J and Mpango, R and Grosskurth, H and Seedat, S and Araya, R and Shahmanesh, M and Patel, V},
             url = {https://doi.org/10.1097/QAI.0000000000001647}
}