Speaker
Description
Background: Depression among people living with HIV on second-line ART is often driven by interconnected factors, including financial hardship, the psychological burden of an HIV diagnosis, and stigma. However, the complex effects of such interconnected constructs have not been well explored.
Objective: This study aimed to examine the direct and indirect factors affecting depression among PLHIV on second-line ART.
Methods: An institutionally based cross-sectional study was conducted from January 13 to April 13, 2025, with 825 PLHIV on second-line ART selected through simple random sampling. Data were collected via face-to-face interviews and document reviews via the Kobo Toolbox and analyzed in STATA version 17. Depression was measured by the PHQ-9, and social support was measured with the Oslo-3 scale. A structural equation modeling analysis was employed. Statistical significance was declared at P < 0.05, and the effect size was reported with 95% CIs.
Results: The prevalence of clinical depression was 49% of PLHIV on second-line ART (95% CI: 46.4, 53.4%). Perceived stigma, nonmedication adherence and internalized stigma had direct positive effects on depression, with [β̂ = 0.69, (95% CI: 0.540, 0.830)], [β̂ = 0.17, (95% CI: 0.076, 0.258)] and [β̂ = 0.33, (95% CI: 0.225, 0.430)], respectively. In addition, social support had direct [β̂ = -0.12, (95% CI: -0.200, -0.035)] and indirect [β̂ = -0.48, (95% CI: -0.58, -0.376)] negative effects on depression mediated through perceived stigma.
Conclusion and recommendations: This finding suggests that perceived and internalized stigma partially mediate the relationship between social support and depression among PLHIV on second-line ART. Furthermore, nonworkable functional status, social support, nonoptimal medication adherence, perceived and internalized stigmas were significant predictors of depression. Hence, healthcare facilities should incorporate and reinforce routine mental health screenings and interventions within HIV care programs. Moreover, acknowledging the substantial effect of stigma on depression is crucial.
