Author(s)

Lilian Bulage^1,2, Benedict Akimana³, Justine D. Namuli⁴, Seggane Musisi⁴, Josephine Birungi⁵, Micheal Etukoit⁵, Ramin Mojtabai⁶, Jean B. Nachega^7,8,9, Edward J. Mills¹⁰, Etheldreda Nakimuli-Mpungu^4*

¹African Field Epidemiology Network, Kampala, Uganda.
²Uganda Public Health Fellowship Program, Kampala, Uganda.
³Ministry of Health, Butabika National Referral Mental Hospital, Kampala, Uganda.
⁴Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
⁵The AIDS Support Organization (TASO), Kampala, Uganda.
⁶Department of Mental Health, Bloomberg’s School of Public Health, Johns Hopkins University, Baltimore, USA.
⁷Departments of Epidemiology, Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA.
⁸Center for Infectious Disease, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹Departments of International Health and Epidemiology, Bloomberg’s School of Public Health, Johns Hopkins University, Baltimore, USA.
¹⁰Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada.

Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressive disorder, factors associated with non-viral suppression remain uncertain. We determined the prevalence and identified the factors associated with viral non-suppression among PLWH with major depressive disorder using ART in Northern Uganda. Method: A total of 30 primary care HIV clinics across three northern districts (Gulu, Kitgum, Pader) participated in the study. Using baseline data from the SEEK-GSP study, a cluster-randomized trial in northern Uganda (2016-2019) that involved 1140 PLWH with mild to moderate major depressive disorder; we examined the demographic, clinical, and psychosocial factors using standardized questionnaires. Data on viral load was abstracted from clinic records and dichotomized into suppressed (<1000 viral copies/mL) and non-suppressed (≥1000 viral copies/mL). We used generalized linear regression models to evaluate the factors associated with non-viral suppression. Results: We recruited 1140 PLWH. The viral non-suppression prevalence was 12.2%. In multivariable analysis, the only baseline psychosocial variable independently associated with non-viral suppression was suicide risk (PRR = 1.56, 95% CI: 1.05 - 2.32, p-value = 0.029). The prevalence odds for non-viral suppression were 56% higher among depressed PLWH with moderate to high suicide risk than those with low suicide risk. Among clinical variables, duration on ART ≥ 4 years was independently associated with non-viral suppression (PRR = 1.62, 95% CI: 1.09 - 2.32, p-value = 0.015). Conclusions: Suicide risk and longer duration on ART are associated with non-viral suppression among anti-retroviral therapy users with mild to moderate major depressive disorder in Uganda. As ART is scaled up across Sub-Saharan Africa, first-line psychological care for depression and its complications is urgently needed in established HIV treatment centers.

Depression, Suicide Risk, Anti-Retroviral Therapy, Viral Suppression, Uganda

Bulage, L. , Akimana, B. , Namuli, J. , Musisi, S. , Birungi, J. , Etukoit, M. , Mojtabai, R. , Nachega, J. , Mills, E. and Nakimuli-Mpungu, E. (2022) Risk Factors for Viral Non-Suppression among People Living with HIV and Major Depressive Disorder in Uganda. World Journal of AIDS, 12, 43-54. doi: 10.4236/wja.2022.122004.