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The Role of Depression in HIV Transmission among People Who Inject Drugs in Vietnam.

Record Type:	Electronic resources : Monograph/item
Title/Author:	The Role of Depression in HIV Transmission among People Who Inject Drugs in Vietnam./
Author:	Levintow, Sara N.
Description:	1 online resource (141 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 82-01, Section: B.
Contained By:	Dissertations Abstracts International82-01B.
Subject:	Epidemiology. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=27833745click for full text (PQDT)
ISBN:	9798641749150

The Role of Depression in HIV Transmission among People Who Inject Drugs in Vietnam.
Levintow, Sara N.

The Role of Depression in HIV Transmission among People Who Inject Drugs in Vietnam. - 1 online resource (141 pages)

Source: Dissertations Abstracts International, Volume: 82-01, Section: B.

Thesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2020.

Includes bibliographical references

The high incidence of HIV among people who inject drugs (PWID) demands closer examination of the drivers of transmission in this population. The burden of depression is high among PWID and may lead to persistent injecting behaviors, insufficient use of antiretroviral therapy (ART), and uncontrolled viremia. This dissertation study investigates the role of depression in transmission risk behaviors, ART initiation, and viral suppression, and models secondary transmission events among PWID in Vietnam, a key population in the country's HIV epidemic. We analyzed data from 455 PWID living with HIV who enrolled in a randomized controlled trial of a prevention intervention in 2009-2013. Study visits every six months over two years measured depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Combining causal inference methods with mathematical modeling, we estimated the effect of depression as risk differences (RDs) in injection equipment sharing and condomless sex, cumulative incidence differences (CIDs) in ART initiation and viral suppression, and differences in total secondary transmissions projected to arise from participants.The prevalence of severe depressive symptoms (CES-D ≥23) was 44% at baseline and 33% on average over follow-up. Severe depressive symptoms (vs. no or mild symptoms) increased injection equipment sharing (RD = 3.9 percentage points, 95% CI: -1.7, 9.6) but decreased condomless sex (RD = -1.8, 95% CI: -6.4, 2.8) in the period three to six months later. Severe depressive symptoms lowered the cumulative incidence of ART initiation at six months (CID = -7.5, 95% CI: -17.2, 2.2) and 12 months (CID = -7.1, 95% CI: -17.9, 3.7), without appreciable differences in viral suppression. Across modeling analyses, the highest numbers of secondary transmissions were modeled for participants with severe depressive symptoms. However, there was substantial variability in model simulations due to the majority of transmissions arising from a small number of participants. Future work probing these mixed findings for the effect of depression on sharing injection equipment (but not condomless sex) and on ART initiation (but not viral suppression) will inform the design of interventions for PWID and shed light on the extent to which successful depression treatment could avert future HIV infections.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2023

Mode of access: World Wide Web

ISBN: 9798641749150Subjects--Topical Terms:

568544
Epidemiology.
Subjects--Index Terms:

DepressionIndex Terms--Genre/Form:

542853
Electronic books.

The Role of Depression in HIV Transmission among People Who Inject Drugs in Vietnam.
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520 $a The high incidence of HIV among people who inject drugs (PWID) demands closer examination of the drivers of transmission in this population. The burden of depression is high among PWID and may lead to persistent injecting behaviors, insufficient use of antiretroviral therapy (ART), and uncontrolled viremia. This dissertation study investigates the role of depression in transmission risk behaviors, ART initiation, and viral suppression, and models secondary transmission events among PWID in Vietnam, a key population in the country's HIV epidemic. We analyzed data from 455 PWID living with HIV who enrolled in a randomized controlled trial of a prevention intervention in 2009-2013. Study visits every six months over two years measured depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Combining causal inference methods with mathematical modeling, we estimated the effect of depression as risk differences (RDs) in injection equipment sharing and condomless sex, cumulative incidence differences (CIDs) in ART initiation and viral suppression, and differences in total secondary transmissions projected to arise from participants.The prevalence of severe depressive symptoms (CES-D ≥23) was 44% at baseline and 33% on average over follow-up. Severe depressive symptoms (vs. no or mild symptoms) increased injection equipment sharing (RD = 3.9 percentage points, 95% CI: -1.7, 9.6) but decreased condomless sex (RD = -1.8, 95% CI: -6.4, 2.8) in the period three to six months later. Severe depressive symptoms lowered the cumulative incidence of ART initiation at six months (CID = -7.5, 95% CI: -17.2, 2.2) and 12 months (CID = -7.1, 95% CI: -17.9, 3.7), without appreciable differences in viral suppression. Across modeling analyses, the highest numbers of secondary transmissions were modeled for participants with severe depressive symptoms. However, there was substantial variability in model simulations due to the majority of transmissions arising from a small number of participants. Future work probing these mixed findings for the effect of depression on sharing injection equipment (but not condomless sex) and on ART initiation (but not viral suppression) will inform the design of interventions for PWID and shed light on the extent to which successful depression treatment could avert future HIV infections.
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