Depression Among Pregnant and Breastfeeding Persons Participating in Two Randomized Trials of the Dapivirine Vaginal Ring and Oral Pre-Exposure Prophylaxis (PrEP) in Malawi, South Africa, Uganda, and Zimbabwe.
Breastfeeding persons
Dapivirine vaginal ring
Depression
HIV prevention
Oral PrEP
Pregnant persons
Journal
AIDS and behavior
ISSN: 1573-3254
Titre abrégé: AIDS Behav
Pays: United States
ID NLM: 9712133
Informations de publication
Date de publication:
25 Mar 2024
25 Mar 2024
Historique:
accepted:
11
03
2024
medline:
25
3
2024
pubmed:
25
3
2024
entrez:
25
3
2024
Statut:
aheadofprint
Résumé
Depression is associated with lower adherence to oral pre-exposure prophylaxis (PrEP) to prevent HIV, but data are not currently available on how depression may affect use of other HIV prevention methods including the dapivirine vaginal ring (DVR). We conducted a mixed methods study using data from the Microbicide Trials Network (MTN) 042/DELIVER (n = 558) and MTN-043/B-PROTECTED (n = 197) studies to describe the prevalence of depressive symptoms and explore how depressive symptoms may have influenced attitudes about use of the monthly DVR and once-daily oral PrEP tablet among pregnant and breastfeeding persons, respectively, in Malawi, South Africa, Uganda, and Zimbabwe. Eleven participants had high Edinburgh Postnatal Depression scores ≥ 10 in MTN-042/DELIVER (2%) and four participants (2%) in MTN-043/B-PROTECTED. In interviews with 9 participants who had high scores (6 DVR, 3 oral PrEP), those with depressive symptoms described overlapping stressors which were magnified by job loss and economic instability during the COVID-19 pandemic, and by experiences of pregnancy/postpartum. These participants experienced a lack of support from partners or family members, and conflict with partners related to trust, and infidelity. While we did not find evidence of a change in product adherence, there was a strong sense of commitment and motivation to use the study products for protection from HIV for participants themselves and their baby. Although lack of social support is usually an obstacle to adherence, in this study, the participants' lives and relationships seemed to have reinforced the need for HIV prevention and motivated women to protect themselves and their babies from HIV.
Identifiants
pubmed: 38526641
doi: 10.1007/s10461-024-04321-2
pii: 10.1007/s10461-024-04321-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Division of Intramural Research, National Institute of Allergy and Infectious Diseases
ID : UM1AI068633
Organisme : Division of Intramural Research, National Institute of Allergy and Infectious Diseases
ID : UM1AI068615
Organisme : Division of Intramural Research, National Institute of Allergy and Infectious Diseases
ID : UM1AI106707
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Moodley D, Esterhuizen TM, Pather T, Chetty V, Ngaleka L. High HIV incidence during pregnancy: compelling reason for repeat HlV testing. AIDS. 2009.
Gray RH, Li X, Kigozi G, Serwadda D, Brahmbhatt H, Wabwire-Mangen F et al. Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study. Lancet. 2005.
Mofenson LM. Risk of HIV Acquisition during pregnancy and Postpartum: a call for action. J Infect Dis. 2018.
Thomson KA, Hughes J, Baeten JM, John-Stewart G, Celum C, Cohen CR et al. Increased risk of HIV Acquisition among women throughout pregnancy and during the Postpartum period: a prospective per-coital-act analysis among women with HIV-Infected partners. J Infect Dis. 2018.
Machekano R, Tiam A, Kassaye S, Tukei V, Gill M, Mohai F et al. HIV incidence among pregnant and postpartum women in a high prevalence setting. PLoS ONE. 2018.
Drake AL, Wagner A, Richardson B, John-Stewart G. Incident HIV during pregnancy and Postpartum and Risk of Mother-to-child HIV Transmission: a systematic review and Meta-analysis. PLoS Med. 2014.
Fisher J, de Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90:139.
doi: 10.2471/BLT.11.091850
Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, le Roux I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8:9.
doi: 10.1186/1742-4755-8-9
pubmed: 21535876
pmcid: 3113332
Manikkam L, Burns JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012;102:940–4.
doi: 10.7196/SAMJ.6009
pubmed: 23498042
Chibanda D, Mangezi W, Tshimanga M, Woelk G, Rusakaniko S, Stranix-Chibanda L, et al. Postnatal depression by HIV status among women in Zimbabwe. J Womens Health (Larchmt). 2010;19:2071–7.
doi: 10.1089/jwh.2010.2012
pubmed: 20849286
Rochat TJ, Richter LM, Doll HA, Buthelezi NP, Tomkins A, Stein A. Depression among pregnant rural South African women undergoing HIV Testing. JAMA. 2006;295:1373–8.
doi: 10.1001/jama.295.12.1376
Rochat TJ, Tomlinson M, Bärnighausen T, Newell ML, Stein A. The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord. 2011;135:362–73.
doi: 10.1016/j.jad.2011.08.011
pubmed: 21880372
pmcid: 3210898
Rochat TJ, Tomlinson M, Newell ML, Stein A. Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh postnatal depression scale (EPDS). Arch Womens Ment Health. 2013;16:401.
doi: 10.1007/s00737-013-0353-z
pubmed: 23615932
pmcid: 3778840
Tsai AC, Scott JA, Hung KJ, Zhu JQ, Matthews LT, Psaros C et al. Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis. PLoS ONE. 2013;8.
Nyamukoho E, Mangezi W, Marimbe B, Verhey R, Chibanda D. Depression among HIV positive pregnant women in Zimbabwe: A primary health care based cross-sectional study. BMC Pregnancy Childbirth [Internet]. 2019 [cited 2022 Apr 7];19:1–7. Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/ https://doi.org/10.1186/s12884-019-2193-y .
Abebe W, Gebremariam M, Molla M, Teferra S, Wissow L, Ruff A. Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia. PLoS ONE. 2022;17.
Psaros C, Smit JA, Mosery N, Bennett K, Coleman JN, Bangsberg DR, et al. PMTCT adherence in pregnant South African women: the role of Depression, Social Support, Stigma, and structural barriers to Care. Ann Behav Med. 2020;54:626–36.
doi: 10.1093/abm/kaaa005
pubmed: 32128556
pmcid: 7459185
Psaros C, Stanton AM, Raggio GA, Mosery N, Goodman GR, Briggs ES et al. Optimizing PMTCT adherence by treating Depression in Perinatal Women with HIV in South Africa: a pilot randomized controlled trial. Int J Behav Med. 2022.
Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. J Acquir Immune Defic Syndr (1988). Lippincott Williams and Wilkins; 2011. p. 181–7.
Uthman OA, Magidson JF, Safren SA, Nachega JB. Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep. 2014;11:291.
doi: 10.1007/s11904-014-0220-1
pubmed: 25038748
pmcid: 4359613
Nachega JB, Uthman OA, Anderson J, Peltzer K, Wampold S, Cotton MF, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012;26:2039–52.
doi: 10.1097/QAD.0b013e328359590f
pubmed: 22951634
Velloza J, Hosek S, Donnell D, Anderson PL, Chirenje M, Mgodi N, et al. Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre-exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial. J Int AIDS Soc. 2021;24:e25731.
doi: 10.1002/jia2.25731
pubmed: 34164929
pmcid: 8222844
Velloza J, Baeten JM, Haberer J, Ngure K, Irungu E, Mugo NR, et al. Effect of depression on adherence to oral PrEP among men and women in East Africa. J Acquir Immune Defic Syndr (1988). 2018;79:330–8.
doi: 10.1097/QAI.0000000000001821
WHO. WHO recommends the dapivirine. vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection [Internet]. World Health Organization. 2021 [cited 2021 Nov 8]. Available from: https://www.who.int/news/item/26-01-2021-who-recommends-the-dapivirine-vaginal-ring-as-a-new-choice-for-hiv-prevention-for-women-at-substantial-risk-of-hiv-infection .
The Health Times. #BREAKING: Dapivirine, Vaginal Ring Approved for Use in Zimbabwe - HealthTimes [Internet]. 2021 [cited 2021 Oct 7]. Available from: https://healthtimes.co.zw/2021/07/14/breaking-dapivirine-vaginal-ring-approved-for-use-in-zimbabwe/ .
Montgomery ET, Hawley I, Fairlie L, Bunge K, Mathebula F, Etima J et al. Acceptability of the dapivirine vaginal ring and oral Truvada among African users in late-stage of pregnancy. AIDS Behav. 2023;(in press).
Stoner MCD, Hawley I, Mathebula F, Horne E, Etima J, Kemigisha D et al. Acceptability and Use of the Dapivirine Vaginal Ring and Daily Oral Pre-exposure Prophylaxis (PrEP) During Breastfeeding in South Africa, Malawi, Zimbabwe, and Uganda. AIDS Behav [Internet]. 2023 [cited 2023 Aug 1];1–10. Available from: https://link.springer.com/article/10.1007/s10461-023-04125-w .
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782–6.
doi: 10.1192/bjp.150.6.782
pubmed: 3651732
Wisner KL, Parry BL, Piontek CM. Postpartum Depression. N Engl J Med. 2002;347:194–9.
doi: 10.1056/NEJMcp011542
pubmed: 12124409
Shrestha SD, Pradhan R, Tran TD, Gualano RC, Fisher JRW. Reliability and validity of the Edinburgh postnatal depression scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2016;16.
Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020;371.
Lawrie TA, Hofmeyr GJ, de Jager M, Berk M. Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women - PubMed. S Afr Med J. 1998;88:1340–4.
pubmed: 9807193
Creswell JW, Plano-Clark VL. Choosing a mixed methods design. Designing and Conducting Mixed Method Research; 2011.
Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016.
Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based Preexposure Prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509–18.
doi: 10.1056/NEJMoa1402269
pubmed: 25651245
pmcid: 4341965
Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367:411–22.
doi: 10.1056/NEJMoa1202614
pubmed: 22784040
pmcid: 3687217
Katz AWK, Naidoo K, Reddy K, Chitukuta M, Nabukeera J, Siva S et al. The power of the Shared experience: MTN-020/ASPIRE trial participants’ descriptions of peer influence on acceptability of and adherence to the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav. 2020.
Stoner MCD, Brown ER, Palanee-Phillips T, Mansoor LE, Tembo T, Nair G et al. The Influence of Perceived Dapivirine Vaginal Ring Effectiveness on Social Disclosure and Ring Adherence. AIDS Behav [Internet]. 2021 [cited 2023 Apr 20];25:4169–79. Available from: https://pubmed.ncbi.nlm.nih.gov/33939034/ .
Palanee-Phillips T, Roberts ST, Reddy K, Govender V, Naidoo L, Siva S et al. Impact of partner-related social harms on women’s adherence to the dapivirine vaginal ring during a phase III trial. J Acquir Immune Defic Syndr (1988). 2018.
Montgomery CM, Lees S, Stadler J, Morar NS, Ssali A, Mwanza B et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV [Internet]. 2008 [cited 2021 May 18];20:733–40. Available from: https://pubmed.ncbi.nlm.nih.gov/18576176/ .
Montgomery ET, Van Der Straten A, Chidanyika A, Chipato T, Jaffar S, Padian N. The importance of male partner involvement for women’s acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS Behav [Internet]. 2011 [cited 2021 May 18];15:959–69. Available from: https://pubmed.ncbi.nlm.nih.gov/20844946/ .
Montgomery ET, van der Straten A, Stadler J, Hartmann M, Magazi B, Mathebula F et al. Male Partner Influence on women’s HIV Prevention Trial Participation and Use of Pre-exposure Prophylaxis: the importance of understanding. AIDS Behav [Internet]. 2015 [cited 2021 May 18];19:784–93. Available from: /pmc/articles/PMC4416996/.
Roberts ST, Nair G, Baeten JM, Palanee-Philips T, Schwartz K, Reddy K et al. Impact of Male Partner involvement on women’s adherence to the Dapivirine Vaginal Ring during a phase III HIV Prevention Trial. AIDS Behav. 2020.
Ali GC, Ryan G, De Silva MJ. Validated Screening Tools for Common Mental disorders in Low and Middle Income countries: a systematic review. PLoS ONE. 2016;11.
JE RU. Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh postnatal depression scale. Acta Psychiatr Scand. 2003;107:251–9.
doi: 10.1034/j.1600-0447.2003.02477.x
Adewuya AO, Ola BA, Dada AO, Fasoto OO. Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women. J Psychosom Obstet Gynaecol. 2006;27:267–72.
doi: 10.1080/01674820600915478
pubmed: 17225628
Dinos S, Ascoli M, Owiti JA, Bhui K. Assessing explanatory models and health beliefs: an essential but overlooked competency for clinicians. BJPsych Adv. 2017;23:106–14.
doi: 10.1192/apt.bp.114.013680
Desai G, Chaturvedi S. Idioms of distress. J Neurosci Rural Pract. 2017;8:S94.
pubmed: 28936079
pmcid: 5602270
Lasater ME, Beebe M, Warren NE, Souko F, Keita M, Murray SM, et al. Dusukasi—the heart that cries: an idiom of Mental Distress among Perinatal women in Rural Mali. Cult Med Psychiatry. 2018;42:930.
doi: 10.1007/s11013-018-9579-6
pubmed: 29696491
pmcid: 6202260
Rao D, Young M, Raguram R. Culture, somatization, and psychological distress: symptom presentation in south Indian patients from a public psychiatric hospital. Psychopathology. 2007;40:349–55.
doi: 10.1159/000106312
pubmed: 17657134
Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S et al. Effect of a primary care-based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. JAMA - J Am Med Association. 2016.
Remien RH, Patel V, Chibanda D, Abas MA. Integrating mental health into HIV prevention and care: a call to action. J Int AIDS Soc [Internet]. 2021 [cited 2021 Sep 26];24:e25748. Available from: https://onlinelibrary.wiley.com/doi/full/ https://doi.org/10.1002/jia2.25748 .