Factors associated with depression among people living with HIV in primary health care of Southern Ethiopia

Abstract

BACKGROUND: Depression is one of the most prevalent mental health disorders among people living with human immunodeficiency virus (PLHIV), with studies estimating depression prevalence in PLHIV remains high (24–42%) in sub-Saharan Africa, nearly twice the rate observed in the general population. Primary health care settings in sub-Saharan Africa often lack standardized mental health screening tools, leading to under diagnosis and untreated depression in PLHIV. This study aims to address this gap by examining the factors associated with depression among PLHIV in n primary health care of Southern Ethiopia. METHODS: A facility-based cross-sectional study was carried out in primary health care setting among adult PLHIV on follow for antiretroviral from January to June of 2023 in Wolaita zone, Southern Ethiopia. A total of 342 sampled adult PLHIV who was registered with an antiretroviral therapy (ART) were included into the study through systematic sampling techniques. Data were collected through face-to-face interviews using structured questionnaires and medical record reviews. Outcome variables (depression symptoms) were assessed using the validated Patient Health Questionnaire-9 (PHQ-9) tool with cutoff score ≥ 10, while exposure variables (clinical/historical factors) were obtained through both self-report and clinical records, with all instruments pretested for local appropriateness. Data were analyzed using STATA version 14, employing bivariate and multivariable logistic regression (p < 0.05 significance) with 95% confidence intervals, preceded by tests for multicollinearity (variance inflation factors < 10) and model fit (Hosmer–Lemeshow p = 0.634). RESULTS: The study included 334 participants, achieving a 97.6% response rate. The prevalence of depression was 30.2% (95% CI: 25.52–35.40). Significant predictors of depression included: age 30–39 years (AOR = 6.40, 95% CI: 1.71–23.9), history of hospital admission (AOR = 3.37, 95% CI: 1.79–6.33), ART duration < 12 months (AOR = 0.26, 95% CI: 0.12–0.58), presence of opportunistic infections (AOR = 2.63, 95% CI: 1.36–5.08), and CD4-positive T cells count ≥ 350 cells/mm3 (AOR = 0.33, 95% CI: 0.12–0.91). CONCLUSIONS: This study found a high depression prevalence (30.2%, 95% CI: 25.52–35.40) among PLHIV, exceeding general population rates and aligning with WHO reports. Integrating routine mental health screening into ART clinics and providing targeted support for groups with higher odds of depression (younger patients, those hospitalized, or with opportunistic infections) is recommended. Multisectoral collaboration with social services and community organizations may help address stigma (reported by 59.6%) and strengthen social support systems.