Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

Abstract Objectives To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). Setting Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. Design Cross-sectional survey. Participants HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least six months. Outcome measures The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire (SSQ-14) score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms, and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms, and suboptimal ART adherence. Results Out of 3,480 adults, 18.8% (95% confidence interval [CI] 14.8-23.7) screened positive for CMD, 2.7% (95% CI 1.5-4.7) reported suicidal ideations, and 1.5% (95% 0.9-2.6) reported perceptual symptoms. Positive CMD screens were more common in women (adjusted prevalence ratio [aPR] 1.67, 95% CI 1.19-2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47 95% CI 1.16-1.85) or aged 50-59 years (20.3%; aPR 1.51 95% CI 1.05-2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37-1.70). Conclusions A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programs in rural Zimbabwe. Strengths and limitations of this study Inclusion of a large sample of people living with HIV recruited at 16 government-funded primary and secondary care facilities in a rural district of Zimbabwe. Use of a locally developed screening tool that showed good psychometric properties for detecting common mental disorders in Zimbabwe in HIV-positive urban populations. The screening tool was not validated for the rural setting, and the cutoff score was selected based on data from the urban setting. Adherence to antiretroviral therapy was self-reported.