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Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis

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Abstract

Despite the substantial burden of HIV in Africa, and the knowledge that depression causes worse HIV outcomes, the burden of depression in people living with HIV in Africa is unknown. We searched Pubmed and four other databases using key terms: depression, Africa, HIV, and prevalence from 2008 to 2018. We summarized depression prevalence by country. We estimated the burden of depression using our prevalence data and 2018 UNAIDS HIV estimates. Our search yielded 70 articles across 16 African countries. The overall prevalence of major depression in those HIV-infected using a diagnostic interview was 15.3% (95% CI 12.5–17.1%). We estimate that 3.63 million (99.7% CI 3.15–4.19 million) individuals with HIV in Sub-Saharan Africa have major depression and provide country-level estimates. We estimate that 1.57 million (99.7% CI 1.37–1.82 million) DALYs are lost among people with depression and HIV in Sub-Saharan Africa. There is a significant burden of depression in Africans with HIV. Further work to screen for and treat depression in Sub-Saharan Africa is needed to improve HIV outcomes and achieve the 90-90-90 UNAIDS goals.

Resumen

A pesar del problema sustancial del VIH en África y el conocimiento de que la depresión causa peores resultados en pacienes con VIH, se desconoce el impacto especifico de la depresión en las personas que viven con el VIH en África. Se realizaron búsquedas en Pubmed y otras cuatro bases de datos utilizando términos clave: depresión, África, VIH y prevalencia desde 2008 hasta 2018. Resumimos la prevalencia de depresión por país. Estimamos el impacto de la depresión utilizando nuestros datos de prevalencia y las estimaciones de VIH de ONUSIDA para 2018. Nuestra búsqueda indetifico 70 artículos en 16 países africanos. La prevalencia general de depresión en las personas infectadas por el VIH durante entrevista de diagnóstico fue del 15,3% (IC del 95% CI 12,5–17,1%). Estimamos que 3.63 millones (99.7% CI 3.15–4.19 millones) de personas con VIH en África Subsahariana sufren de depresión y proporcionamos estimaciones a nivel país. Estimamos que se pierden 1,57 millones (IC del 99,7%, 1,37–1,82 millones) de AVAD entre las personas con depresión y VIH en el África subsahariana. La depresión tiene un impacto significativo en los africanos con VIH. Se necesitan más estudios para detectar y tratar la depresión en África subsahariana con el fin de mejorar los resultados del VIH y alcanzar los objetivos 90-90-90 de ONUSIDA.

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Acknowledgements

This research was supported by the National Institute of Neurologic Diseases and Stroke (NINDS), Fogarty International Center (R01NS086312, R25TW009345), the National Institute of Allergy and Infectious Diseases (T32AI055433), and the National Institute of Mental Health (K23 MH121220). We thank Jose Debes for his kind help in translating our abstract into Spanish.

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Authors and Affiliations

  1. Division of Infectious Diseases and International Medicine, Department of Minnesota, University of Minnesota, 420 Delaware Street, SE, MMC 250, Minneapolis, MN, 55455, USA

    S. M. Lofgren & D. R. Boulware

  2. Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA

    D. J. Bond

  3. Department of Psychiatry, Makerere University, Kampala, Uganda

    N. Nakasujja

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  1. S. M. Lofgren
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  2. D. J. Bond
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  3. N. Nakasujja
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  4. D. R. Boulware
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Correspondence to S. M. Lofgren.

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Lofgren, S.M., Bond, D.J., Nakasujja, N. et al. Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis. AIDS Behav 24, 1752–1764 (2020). https://doi.org/10.1007/s10461-019-02706-2

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