Psychological Distress and Adherence to Anti-retro Viral Treatment among HIV-infected Adolescents in Uganda.

Abstract

Psychological distress among HIV-infected adolescent has been associated with non-adherence to anti-retroviral therapy (ART), leading to increased risk for AIDS morbidity and mortality. However, data on prevalence and correlates of psychological distress in low-income countries are scarce, and efforts to establish the nature, prevalence, and presentation of psychological distress in these settings are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress among HIV-infected adolescents aged 12-19 years in Uganda, generate knowledge on the predictors of psychological distress in this population, and assess the impact of psychological distress on adherence to ART, net of mitigating psychosocial resources. Using mixed method approaches and a sample of 511 HIV-infected adolescents, a 25-item scale, with six scales was developed and tested. The subscales were labeled as: anhedonia, depressive-anxiety, isolation, suicidal ideation, sleep problems, and somatization. Reliability of the subscales was adequate, with Cronbach’s alpha ranging from 0.615 to 0.732 for the subscales, and 0.89 for entire scale. Confirmatory factor analysis indicated that the scale structure was consistent with the data with RMSEA < 1.0, and CFI and TLI > 0.90. An exploratory factor analysis supported use of a composite global psychological distress score. Psychological distress was positively associated with negative events, stigma, on-going worries, poverty-related hardships, and HIV-related concerns, and negatively associated with psychosocial resources such as spirituality, coping, satisfaction with social support. Psychosocial resources partially mediated the effects of stressors on psychological distress. In the logistic regression analyses, psychological distress was associated with 75%, 63% and 79% increase in odds for non-adherence using self-reported missed pills, following medical regimen and visual analog scale measures, respectively, and 30% increase in the odds for non-adherence in the Structural Equation Model (SEM) analyses. In these analyses, psychosocial resources partially mediated the effect of psychological distress on non-adherence. Non-adherence was positively associated with frequency of praying privately and negatively associated with satisfaction with social support. The findings in this study underscore the need for interventions to prevent or reduce psychological distress among HIV-infected adolescents, thereby improving adherence to ART.