Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia. A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients’ adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL. Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001). The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.

中文翻译：

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重度抑郁症及其与抗逆转录病毒治疗依从性和生活质量的关系：对埃塞俄比亚西北部艾滋病毒/艾滋病患者的横断面调查


据信，重度抑郁症会影响艾滋病毒/艾滋病患者 (PLWHA) 的治疗依从性和整体生活质量 (QoL)。共病重度抑郁症导致 PLWHA 的死亡风险增加两倍。了解重度抑郁症、抗逆转录病毒治疗 (ART) 依从性和生活质量之间的关系对于确定干预领域非常重要。本研究的目的是探讨重度抑郁症 (MDD) 和 ART 依从性与生活质量的关系，并调查埃塞俄比亚西北部 PLWHA 中与 MDD、依从性和生活质量相关的社会人口统计学和临床​​因素。 2019 年 7 月至 10 月，在埃塞俄比亚西北部 Felege-Hiwot 转诊医院的 ART 诊所进行了一项横断面研究。采用系统随机抽样技术选择成人感染者。使用访谈问卷和图表审查收集数据。迷你国际神经精神访谈和 WHOQOL-HIV-BREF-Eth 仪器分别用于测量 MDD 和 QoL。使用患者依从性监测图表中的药丸计数数据来评估对 ART 的依从性。使用单变量和多变量泊松回归来评估社会人口统计学和临床​​因素与 MDD 和 ART 依从性的关联。使用多元线性回归来检查 MDD 和依从性与整体生活质量的关联。在总共 393 名受邀参与者中，391 人（99.5%）完成了访谈。 MDD 与整体生活质量呈负相关：与没有 MDD 的参与者相比，患有 MDD 的参与者的生活质量得分较低，为 0.17 分。当功能障碍得到控制时，MDD 与 ART 依从性降低相关（RR = 1.43；95% CI = 1.05, 1.96；p = 0.025）。 然而，ART 的依从性与总体生活质量之间没有统计学关联。功能障碍与 MDD（RR = 5.07；95%CI = 3.27,7.86；p < 0.001）和总体 QoL（β = 0.29；95%CI = 0.21,0.36；p < 0.001）相关。 MDD 和生活质量之间的关系表明，需要采取可行、可接受和循证的心理健康干预措施，以减少抑郁症并提高感染者的整体生活质量。我们建议未来的研究调查 MDD、ART 依从性和 PLWHA 的生活质量之间的因果关系，以更好地了解干预的优先领域。