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Depressive symptoms and use of HIV care and medication assisted treatment among people living with HIV who inject drugs

Developed by Indonesia ITTC

Published on 3/1/2021

Introduction



Pendahuluan



Depression is the most commonly reported neuropsychiatric complication among people living with HIV (PLWH). The prevalence of depression symptoms in people who inject drugs (PWID) is even higher. Depression may negatively affect HIV treatment initiation and adherence and may increase mortality among PLWH who inject drugs. This article aimed to assess



Depresi merupakan komplikasi neuropsikiatrik yang umum dilaporkan pada penderita HIV. Prevalensi gejala depresi cukup tinggi pada penasun. Depresi dapat mempengaruhi inisiasi pengobatan HIV dan kepatuhan pengobatan secara negatif serta dapat meningkatkan angka kematian pada penasun penderita HIV.



 



HPTN 074 was a randomized, controlled, phase 3 feasibility and efficacy study among index PLWH who inject drugs and their HIV-negative injecting partners. The study was conducted in 3 sites: Kyiv, Ukraine; Thai Nguyen, Vietnam; and Jakarta, Indonesia.



HPTN 074 merupakan studi fase 3 yang acak dan terkendali untuk menilai efikasi dan kelayakan intervensi pada penasun penderita HIV (partisipan indeks) dan pasangan menyuntiknya yang HIV negative. Studi ini dilaksanakan di 3 negara: Kyiv, Ukraina; Thai Nguyen, Vietnam; dan Jakarta, Indonesia.



 



Methods



Metode



Moderate-to-severe depression was defined as a Patient Health Questionnaire (PHQ-9) score of 10 or above. ART and MAT were self-reported. Eligibility criteria were: 18–60 years of age, active IDU, and viral load ≥1000 cp/mL. Adjusted probability differences (aPD) were estimated using inverse-probability weighting.



Depresi tingkat sedang-berat didefinisikan sebagai skor Patient Health Questionnaire (PHQ-9) 10 atau lebih. Obat ARV dan MAT merupakan lapor mandiri (oleh partisipan). Kriteria kelayakan adalah: usia 18 – 60 tahun, penasun aktif, dan viral load > 1,000 kopi/mL. Adjusted probability differences (aPD) diukur menggunakan inverse-probability weighting.



 



Results



Hasil Penelitian



At study entry, the estimated prevalence of moderate/severe depression symptoms was heterogeneous across sites: 14% in Indonesia, 56% in Ukraine, and 14% in Vietnam. Median PHQ-9 depression scores were 4 (Q1, Q3: 3, 7) in Indonesia, 10 (7, 15) in Ukraine, and 5 (2, 8) in Vietnam.



Pada awal penelitian, prevalensi gejala depresi sedang/berat beragam di ketiga site: 14% di Indonesia, 56% di Ukraina, dan 14% di Vietnam. Median dari skor depresi PHQ-9 adalah 4 (Q1, Q3: 3, 7) di Indonesia, 10 (7, 15) di Ukraine, dan 5 (2, 8) di Vietnam.



 



No evident associations were detected between baseline depression and ART, viral suppression, or MAT at 12-month follow-up. The study intervention improved the proportions of PWID achieving 12-month viral suppression in both the depressed (intervention 44%; standard of care (SOC) 24%; estimated aPD=25% [95%CI: 4.0%, 45%]) and non-depressed subgroups (intervention 38%; SOC 24%; aPD=13% [95%CI: 2.0%, 25%]).



Tidak ada hubungan yang jelas terdeteksi antara depresi pada baseline dengan obat ARV, supresi virus, atau MAT pada follow-up bulan ke-12. Intervensi dalam penelitian inii meningkatkan proporsi penasun mencapai supresi virus di bulan ke-12, baik di sub-kelompok depresi (intervensi 44%; layanan standar 24%; estimasi aPD=25% [95%CI: 4.0%, 45%]) maupun sub-kelompok non-depresi (intervensi 38%; layanan standar 24%; aPD=13% [95%CI: 2.0%, 25%]).



 



Conclusions



Kesimpulan



Prevalence of depressive symptoms measured by PHQ-9 was strikingly higher in Ukraine as compared to Vietnam and Indonesia. But we saw little relationship between baseline depressive symptoms among PLWH who inject drugs on ART use, MAT uptake, viral suppression, daily IDU and mortality. Importantly, the study intervention was effective in improving ART use and viral suppression among participants with or without baseline depression.



Prevalensi gejala depresi yang diukur menggunakan PHQ-9 sangat tinggi di Ukraina dibandingkan dengan Vietnam dan Indonesia. Namun, tidak ada hubungan bermakna antara gejala depresi di baseline pada penasun penderita HIV dengan penggunaan obat ARV, serapan MAT, supresi virus, penggunaan NAPZA suntik harian dan angka kematian. Yang terpenting, intervensi studi ini efektif dalam meningkatkan penggunaan obat ARV dan supresi virus pada partisipan dengan atau tanpa gejala 


https://www.hptn.org/research/publications/956

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The International Consortium of Universities for Drug Demand Reduction (ICUDDR) supports the rapid improvement in competencies and skills among current and future generations of addiction professionals to meet the increasing demand for prevention, treatment and public health services. Toward this end, the ICUDDR facilitates networking among universities to promote high quality education and training in the field of addiction prevention, treatment and public health interventions. It also pursues related applied addictions research, outreach and advocacy.

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