J Acquir Immune Defic Syndr. 2023 Mar 27. doi: 10.1097/QAI.0000000000003193. Online ahead of print.
ABSTRACT
BACKGROUND: In Zambia, half of children and adolescents living with HIV (CALWH) on antiretroviral therapy (ART) are virologically unsuppressed. Depressive symptoms are associated with ART non-adherence but have received insufficient attention as mediating factors in the relationship between HIV self-management and household-level adversities. We aimed to quantify theorized pathways from indicators of household adversity to ART adherence, partially mediated by depressive symptoms, among CALWH in two Zambian provinces.
SETTING: In July-September 2017, we enrolled 544 CALWH aged 5-17 years and their adult caregivers into a year-long prospective cohort study.
METHODS: At baseline, CALWH-caregiver dyads completed an interviewer-administered questionnaire, which included validated measures of recent (past 6 months) depressive symptomatology and self-reported past-month ART adherence (never versus sometimes or often missing medication doses). We used structural equation modeling with theta parameterization to identify statistically significant (p<0.05) pathways from household adversities (past-month food insecurity, caregiver self-reported health) to depression (modeled latently), ART adherence, and poor physical health in the past 2 weeks.
RESULTS: Most CALWH (mean age: 11 years, 59% female) exhibited depressive symptomatology (81%). In our structural equation model, food insecurity significantly predicted elevated depressive symptomatology (ß = 0.128), which was associated inversely with daily ART adherence (ß = -0.249) and positively with poor physical health (ß = 0.359). Neither food insecurity nor poor caregiver health were directly associated with ART non-adherence or poor physical health.
CONCLUSIONS: Using structural equation modeling, we found that depressive symptomatology fully mediated the relationship between food insecurity, ART non-adherence, and poor health among CALWH.
PMID:36976552 | DOI:10.1097/QAI.0000000000003193
