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Probable antenatal depression at antiretroviral initiation and postpartum viral suppression and engagement in care

Harrington, Bryna J.a; Pence, Brian W.a; Maliwichi, Madalitsob; Jumbe, Allan N.b; Gondwe, Ntchindi A.b; Wallie, Shaphil D.b; Gaynes, Bradley N.a; Maselko, Joannaa; Miller, William C.c; Hosseinipour, Mina C.a,b on behalf of the S4 Study team

doi: 10.1097/QAD.0000000000002025

Objective: To estimate the association of probable antenatal depression with postpartum HIV care engagement among pregnant women in Malawi.

Design: We conducted a prospective cohort study of 299 women who were initiating antiretroviral therapy (ART) through Option B+ at a government antenatal clinic in Malawi.

Methods: Probable antenatal depression was assessed on the day of ART initiation with the validated Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS). We estimated crude and adjusted risk differences (RD, aRD) of visit attendance and prevalence differences (PD, aPD) of viral suppression through 12 months post-ART initiation comparing women with versus without probable antenatal depression.

Results: One in 10 women had probable antenatal depression. Most women were engaged in care through 12 months post-ART initiation: 85% attended all scheduled ART visits, and 81% were in care and virally suppressed. Women with and without probable antenatal depression had a comparable probability of attending all scheduled visits (RD: −0.02; 95% CI −0.16 to 0.12; aRD: −0.04; 95% CI −0.18 to 0.10), and of viral suppression (PD: −0.02; 95% CI −0.17 to 0.13; aPD: −0.01; 95% CI −0.17 to 0.15) in crude and adjusted analyses.

Conclusion: Probable antenatal depression was not associated with engagement in HIV care through 12 months post-ART initiation. In a population with high HIV care engagement, antenatal depression may not impair HIV-related outcomes.

aDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA

bUNC Project Malawi, Lilongwe, Malawi

cCollege of Public Health, The Ohio State University, Columbus, Ohio, USA.

Correspondence to Bryna J. Harrington, PhD, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall CB#7435, Chapel Hill, NC 27599, USA. Tel: +1 919 966 7430; e-mail:

Received 14 April, 2018

Accepted 22 June, 2018

Copyright © 2018 Wolters Kluwer Health, Inc.