Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2024-07-18 DOI:10.1002/jia2.26320

Gaukhar Mergenova, Alissa Davis, Louisa Gilbert, Nabila El-Bassel, Assel Terlikbayeva, Sholpan Primbetova, Zhamilya Nugmanova, Andrea Norcini Pala, Deborah Gustafson, Susan L. Rosenthal, Alfiya Y. Denebayeva, Jack DeHovitz

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引用次数: 0

Abstract

Introduction

There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.

Methods

We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.

Results

Participants’ median age was 40.0 (IQR: 34−47) with 40.9% (n = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, p < 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, p < 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, p < 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, p < 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, p < 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, p < 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, p < 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, p < 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, p < 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, p < 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, p < 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, p < 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, p < 0.005) symptoms had lower ASES scores.

Conclusions

Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness were associated with poorer ART adherence and worse adherence self-efficacy. It is crucial to assess and treat mental illness and provide support for PLWH with worsened cognition to enhance ART adherence.

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哈萨克斯坦艾滋病毒感染者的心理健康和认知与坚持抗逆转录病毒疗法的关系：横断面研究

导言：在哈萨克斯坦，心理健康和认知与艾滋病病毒感染者（PLWH）坚持抗逆转录病毒治疗（ART）之间存在研究空白。方法我们从阿拉木图市艾滋病中心登记处（2019 年 6 月至 11 月）随机挑选并招募了 230 名艾滋病病毒感染者参与横断面研究。我们研究了最近1周和2周自我报告的抗逆转录病毒疗法依从性、依从自我效能量表（ASES）与抑郁症状（患者健康问卷-9 [PHQ-9]）、焦虑（广泛性焦虑症工具 [GAD-7]）、创伤后应激障碍（创伤后应激障碍清单 [PTSD]）、认知功能（PROMIS v2.0 成人认知功能 8a 短表）和遗忘（遗忘评估量表）之间的关联。PHQ-9 和 GAD-7 的症状严重程度≥5 为轻度，≥10 为中度；创伤后应激障碍的症状严重程度≥44 为中度。采用逻辑和线性回归分析。结果参与者的年龄中位数为 40.0 岁（IQR：34-47），其中女性占 40.9%（n = 94）。在过去两周内至少错过一次服药的参与者报告至少有轻度抑郁（aOR = 3.34，95% CI：1.22-9.11，p < 0.05）、轻度焦虑（aOR = 3.27，95% CI：1.20-8.92，p < 0.05）和创伤后应激障碍（aOR = 4.04，95% CI：1.15-14.21，p < 0.05）症状的几率更高。上周至少漏服一片药物的参与者至少出现轻度抑郁（aOR = 7.74，95% CI：1.31-45.7，p < 0.05）、中度焦虑（aOR = 21.33，95% CI：3.24-140.33，p < 0.005）和创伤后应激障碍（aOR = 13.81，95% CI：2.36-80.84，p < 0.005）症状的几率更高。认知功能较好的参与者最近一周不坚持治疗的几率较低（aOR = 0.88，95% CI：0.81-0.96，p < 0.005），ASES 评分较高（β = 0.26，95% CI：0.13-0.40，p < 0.005）。记忆力差与最近一周不坚持治疗的几率较高（aOR = 4.64，95% CI：1.76-12.24，p < 0.005）和较低的 ASES 分数（β = -0.31，95% CI：-0.45 至 0.16，p < 0.005）有关。至少有轻度抑郁（β = -0.21，95% CI：-0.35 至 -0.07，p < 0.005）、中度焦虑（β = -0.21，95% CI：-0.34 至 -0.07，p < 0.005）和创伤后应激障碍（β = -0.19，95% CI：-0.33 至 -0.05，p < 0.005）症状者的 ASES 分数较低。结论抑郁、焦虑和创伤后应激障碍症状、较差的认知能力和健忘与较差的抗逆转录病毒疗法依从性和较差的依从自我效能有关。对认知能力下降的 PLWH 进行精神疾病评估和治疗，并为其提供支持以提高抗逆转录病毒疗法的依从性至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.