Correlates of Depression in ART Adherence among Youths in Lilongwe, Malawi
Abstract
:1. Introduction
1.1. ART Services in Malawi
1.2. Conceptual Framework
1.3. Justification
2. Materials and Methods
2.1. Study Design
2.2. Study Place
2.3. Study Population
2.4. Sample Size and Sampling
2.5. Data Collection
2.5.1. Quantitative Method
2.5.2. Qualitative Method
2.6. Data Analysis
2.7. Ethical Considerations
3. Results
3.1. Quantitative Findings
3.1.1. Social and Demographic Characteristics of Study Participants
3.1.2. ART Adherence (Viral Load) Characteristics
3.1.3. Depression among the Youths
3.1.4. Bivariate Analysis
3.1.5. Multivariate Logistic Regression Results
3.2. Qualitative Findings
3.2.1. Explanatory Models for ART Non-Adherence amongst the Youths
Lack of Basic Needs
“Sometimes I am always busy doing peace work to earn money for my daily living, hence forgetting to take my daily medications” (Youth).
Lack of Privacy
“The youths who are in boarding facilities are challenged with privacy as they want to hide that they are on ARV’s and others are in an exploratory phase of different social behaviours, for example, smoking, alcohol and drug use influenced by their peers and later makes them forget taking ARV’s or stops taking ART” (ART Clinician).
“Because ARVs are unlike other drugs, they need strict privacy so that people will not discriminate against you. For instance, in the last six months of ART appointments, I have missed doses three times since I was at school, and there were many friends around me which made me fail to take up my ARV as prescribed” (Youth).
Psychological Trauma
“My relation once disclosed my status to others by speaking bad words such as look at this one. He is HIV positive, and this honestly made me think of stopping taking ARV’s so that I die and follow my parents, and sometimes it’s because of self-disclosure due to angriness that you have tested positive” (Youth)
3.3. Explanatory Models for Depression among the youths
3.3.1. Incomplete HIV Status Disclosure
“They tend to ask why they are the only ones with HIV in their house and why their parents failed to disclose to them when they were alive, which triggers confusion” (Psychosocial counsellor).
3.3.2. Shortage of Psychosocial Providers
“Only those youths presenting with depression symptoms are the ones given a chance to access the services on the adolescent clinic days because of shortage of psychosocial providers which even compromise on the quality of counselling services we do provide to the youths” (Psychosocial counsellor).
3.3.3. Knowledge Deficit of ART Providers to Screen Depression
“Other ART providers are not knowledgeable and skilled on youth’s depression assessments, which compromise the quality of care they receive at the clinic” (Nurse ART provider).
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Frequency (n = 303) |
---|---|
Sex | |
Male | 139 (46%) |
Female | 164 (54%) |
Total | 303 (100%) |
Marital status | |
Never married | 278 (92%) |
Married | 22 (7%) |
Divorced | 3 (1%) |
Widow | 0 |
Total | 303 (100%) |
Religion | |
Christianity | 273 (90%) |
Islam | 30 (10%) |
Total | 303 (100%) |
Education | |
None | 1 (0.3%) |
Primary | 100 (33%) |
Secondary | 192 (63%) |
Tertiary | 10 (3%) |
Total | 303 (100%) |
Source of income | |
Self | 45 (15%) |
Parents | 223 (74%) |
Guardians | 35 (12%) |
Total | 303 (100%) |
Alcohol consumption | |
No | 271 (89%) |
Yes | 32 (11%) |
Total | 303 (100%) |
Sexual behaviour | |
None | 271 (89%) |
One partner | 75 (25%) |
Two partners | 14 (5%) |
>Two partners | 7 (2%) |
Total | 303 (100%) |
Characteristics | Suppressed (n = 236) n (%) | Unsuppressed (n = 67) n (%) | p-Value |
---|---|---|---|
Age | |||
15–19 | 65 (28%) | 22 (33%) | |
20–24 | 171 (72%) | 45 (67%) | |
Total | 236 (100%) | 67 (100%) | 0.398 |
Sex | |||
Male | 110 (47%) | 28 (42%) | |
Female | 126 (53%) | 39 (58%) | |
Total | 236 (100%) | 67 (100%) | 0.485 |
Marital status | |||
Never married | 226 (96%) | 63 (94%) | |
Married | 8 (3%) | 3 (4%) | |
Divorced | 2 (0.8%) | 1 (2%) | |
Total | 236 (100%) | 67 (100%) | 0.816 |
Religion | |||
Christianity | 215 (91%) | 58 (87%) | |
Islam | 21 (9%) | 9 (13%) | |
Total | 236 (100%) | 67 (100%) | 0.273 |
Education | |||
None | 0 | 1 (2%) | |
Primary | 78(33%) | 22 (33%) | |
Secondary | 150(64%) | 24 (36%) | |
Tertiary | 8((3%) | 2 (3%) | |
0.314 | 236(100%) | 67 (100%) | |
Source of income | |||
Self | 35 (15%) | 10 (15%) | |
Parents | 173 (73%) | 50 (78%) | |
Guardians | 28 (12%) | 7 (10%) | |
Total | 236 (100%) | 67 (100%) | 0.950 |
Alcohol consumption | |||
No | 212 (90%) | 59 (88%) | |
Yes | 24 (10%) | 8 (12%) | |
Total | 236 (100%) | 67 (100%) | 0.677 |
Sexual behaviour | |||
None | 159 (67%) | 48 (72%) | |
One partner | 59 (25%) | 16 (24%) | |
Two partners | 13 (6%) | 1 (1%) | |
>two partners | 5 (2%) | 2 (3%) | |
Total | 236 (100%) | 67(100% | 0.541 |
Characteristics | None (n = 232) | Mild (n = 51) | Moderate (n = 19) | Severe (n = 1) | p-Value |
---|---|---|---|---|---|
Age | |||||
15–19 | 72 (31%) | 10 (20%) | 5 (26%) | 0 | |
20–24 | 160 (69%) | 41 (80%) | 14 (74%) | 1 (100%) | |
Total | 232 (100) | 51 (100) | 19 (100) | 1 (100%) | 0.372 |
Sex | |||||
Male | 103 (44%) | 27 (53%) | 8 (42%) | 0 | |
Female | 129 (56%) | 24 (47%) | 11 (58%) | 1 (100%) | |
Total | 232 (100) | 51 (100) | 19 (100) | 1 (100) | 0.537 |
Marital status | |||||
Never married | 220 (95%) | 49 (96%) | 19 (100%) | 1 (100%) | |
Married | 9 (4%) | 2 (4%) | 0 | 0 | |
Divorced | 3 (1%) | 0 | 0 | 0 | |
Total | 232 (100%) | 51 (100%) | 19 (100%) | 1 (100%) | 0.941 |
Religion | |||||
Christianity | 210 (91%) | 44 (86%) | 18 (95%) | 1 (100%) | |
Islam | 22 (9%) | 7(14%) | 1 (5%) | 0 | |
Total | 232 (100%) | 51 (100%) | 19 (100%) | 1 (100%) | 0.694 |
Education | |||||
None | 1 (0.4%) | 0 | 0 | 0 | |
Primary | 77 (33%) | 16 (31%) | 7 (37%) | 0 | |
Secondary | 145 (63%) | 35 (69%) | 11 (58%) | 1 (100%) | |
Tertiary | 9 (4%) | 0 | 1 (5%) | 0 | |
Total | 232 (100%) | 51 (100%) | 19 (100%) | 1 (100%) | 0.942 |
Source of income | |||||
Self | 31 (13%) | 9 (18%) | 5 (26%) | 0 | |
Parents | 183 (79%) | 29 (57%) | 10 (53%) | 1 (100%) | |
Guardians | 18 (8%) | 13 (25%) | 4 (21%) | 0 | |
Total | 232 (100%) | 51 (100%) | 19 (100%) | 1 (100%) | 0.003 |
Alcohol consumption | |||||
No | 211 (91%) | 45 (88%) | 15 (79%) | 0 | |
Yes | 21 (9%) | 6 (12%) | 4 (21%) | 1 (100%) | |
Total | 232 (100%) | 51 (100%) | 19 (100%) | 1 (100%) | 0.010 |
Sexual behaviour | |||||
None | 169 (73%) | 26 (51%) | 12 (63%) | 0 | |
One partner | 51 (22%) | 17 (33%) | 6 (32%) | 19 (100%) | |
Two partners | 7 (3%) | 7 (14%) | 0 | 0 | |
>Two partners | 5 (2%) | 1 (2%) | 1 (5%) | 1 (100%) | |
Total | 232 (100%) | 51 (100%) | 19 (100%) | 1 (100%) | 0.014 |
Variable | Odds Ratio | p > [z] | 95% Confidence Level | |
---|---|---|---|---|
Source of income | ||||
Self (reference) | 1 | |||
Parents | 0.5975 | 0.188 | 0.2777 | 1.2855 |
Guardians | 2.3149 | 0.08 | 0.904 | 5.9271 |
Alcohol consumption | ||||
No (reference) | 1 | |||
Yes | 1.8993 | 0.142 | 0.8065 | 4.4728 |
Sexual behaviour | ||||
None (reference) | 1 | |||
One partner | 2.01314 | 0.024 | 1.0976 | 3.7596 |
Two partners | 2.1197 | 0.172 | 0.7211 | 6.2304 |
More than two | 1.0967 | 0.922 | 0.1729 | 6.9553 |
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Msefula, M.C.; Umar, E. Correlates of Depression in ART Adherence among Youths in Lilongwe, Malawi. Trop. Med. Infect. Dis. 2024, 9, 2. https://doi.org/10.3390/tropicalmed9010002
Msefula MC, Umar E. Correlates of Depression in ART Adherence among Youths in Lilongwe, Malawi. Tropical Medicine and Infectious Disease. 2024; 9(1):2. https://doi.org/10.3390/tropicalmed9010002
Chicago/Turabian StyleMsefula, Mary Carolyne, and Eric Umar. 2024. "Correlates of Depression in ART Adherence among Youths in Lilongwe, Malawi" Tropical Medicine and Infectious Disease 9, no. 1: 2. https://doi.org/10.3390/tropicalmed9010002
APA StyleMsefula, M. C., & Umar, E. (2024). Correlates of Depression in ART Adherence among Youths in Lilongwe, Malawi. Tropical Medicine and Infectious Disease, 9(1), 2. https://doi.org/10.3390/tropicalmed9010002