Background: Depression is the leading cause of disability globally and is associated with poor HIV clinical outcomes. Risk of depression is higher in HIV-infected individuals and in peripartum women, but few studies have characterized depression in pregnant HIV-infected women in sub-Saharan Africa. This study evaluates the prevalence and correlates of depression in pregnant HIV-infected women in Kenya.
Methods: We conducted a cross-sectional analysis of enrollment data from participants in a trial evaluating mHealth strategies to improve ART adherence (Mobile WAChX, NCT02400671). Participants were age ≥14, HIV-infected, pregnant, and had daily access to mobile phone. Participants were recruited from 6 public MCH clinics in Nairobi and Nyanza region. Self-report questionnaires were administered, including assessment of depression (by PHQ9) and social support (by MOS). Correlates of depression were assessed by χ² test, univariable and multivariable logistic regression with standard errors clustered by clinic.
Results: Among 825 women enrolled, median age was 27 (IQR 23-31), median gestational age was 24 weeks (18-30), median time since HIV diagnosis was 2 years (IQR 0.08-5.00), and 452 (55%) had an intended pregnancy. Overall, 244 (29.6%) reported at least mild depression (PHQ9 score ≥5) and 71 (8.6%) reported at least moderate depression (PHQ9 score ≥10). Prevalence of ≥mild depression varied significantly by clinic site (range 7.8%-36.5%, p< 0.0001). Compared to women without depression, women with ≥mild depression had lower income, education, and were less likely to have had an intended pregnancy (p< 0.05 for each). In addition, women with ≥mild depression had a more recent HIV diagnosis (median 1 vs. 2 years, p=0.006), more enacted stigma (21.5% vs. 9.3%, p< 0.001), IPV (20.5 vs. 7.2%, p< 0.001) and less social support (58 vs. 66, p< 0.001). In adjusted analysis, depression remained associated with poor social support (aOR=0.98, 0.97-0.99), unplanned pregnancy (aOR=1.35, 1.07-1.71), less than primary education (aOR=1.45, 1.03-2.04), and IPV in the last 12 months (aOR=2.89, 2.45-3.40).
Conclusions: Prevalence of depression in HIV-infected pregnant women in Kenya was substantial, and was associated with pregnancy intention, IPV, education level and social support. The findings highlight the need for improved depression screening and treatment for pregnant HIV-infected women.