Depression, retention in care, and uptake of PMTCT service in Kinshasa, the Democratic Republic of Congo: a prospective cohort

ABSTRACT

There is a clear need for effective strategies to address the factors that affect retention, or lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and (1) LTFU or (2) uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly diagnosed HIV-infected women in Kinshasa, DRC.

KEYWORDS:

• Depression
• PHQ-9
• PMTCT
• retention
• lost-to-follow-up
• Kinshasa

Acknowledgements

KY and MY designed the analysis. KY, KF, and MY analyzed the data. KY and MY wrote the first draft of the report. All authors contributed to the final report. We are grateful for the participation and time of the mothers and infants in the study, the time and efforts of the personnel of the participating clinics, the technical support of Drs Jean Lambert Chalachala, Bienvenu Kawende, Landry Kiketa, Noro Lantoniaina Rosa Ravelomanana, and Landry Wenzy; the data collection and data entry contributions of Josée Nlandu Babela, Valerie B. Chalachala, Fanny Matadi, Espérance Mindia, and Georges Kihuma Nganguli, and the support of the Ohio State University’s, University of North Carolina’s, and the Kinshasa School of Public Health’s administrative teams.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kelly A. Yotebieng http://orcid.org/0000-0002-0511-3237

Marcel Yotebieng http://orcid.org/0000-0003-2110-2631

Additional information

Funding

This parent study was supported by a grant from the President’s Emergency Plan for AIDS Relief (PEPFAR) and the National Institute of Child Health and Human Development (NICHD) [R01 HD075171]. MY is partially supported by the NIAID [U01AI096299-01] and the NICHD [R01 HD087993]. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication.