Association between Depression and adherence to use of Antiretroviral agents in HIV Patients at the ARV Clinic, Chatturat Hospital.

Abstract

Objectives: Depression among people living with HIV  is a major mental health issue, with a prevalence 2 to 4 times higher than that of the general population. It directly affects adherence to antiretroviral therapy (ART), which is a key determinant of long-term treatment success. This cross-sectional analytical study aimed to:

          1) investigate the relationship between depression and ART adherence among HIV-infected patients, and

          2) assess the prevalence of depression within this patient population.

Materials and Methods: A cross-sectional analytical study was conducted among HIV-infected outpatients at the Antiretroviral Clinic of Chatturat Hospital, Chaiyaphum Province. Data were collected from a sample of 157 participants between December 1, 2025, and February 28, 2026. The research instruments consisted of structured interview questionnaires designed to assess depression levels and ART adherence. Data were analyzed using descriptive statistics and multivariate inferential statistics to determine independent associations.

Results: The demographic characteristics of the sample in this study context were predominantly middle-aged, with a mean age of 49.22 ± 11.12 years, and they were on long-term antiretroviral therapy (ART). The mean duration since initiating ART was 12.25 ± 5.61 years. Most participants demonstrated excellent ART adherence, with a mean continuous adherence rate of 94.92% (SD = 6.97), which nearly reached the clinical benchmark for effective treatment (95%).

When categorized by the severity of depression, the majority of the sample did not report severe mental health issues. Patients without depression constituted the largest group at 71.34%, while 28.66% experienced depression ranging from mild to severe. However, the proportions of moderate, high, and severe depression were relatively low, collectively accounting for approximately 4.46%.

Good ART adherence (≥95%) was significantly associated with a lower likelihood of developing depression (Adjusted OR = 0.08, p = 0.006). Family support emerged as the most distinct protective factor (Adjusted OR = 0.04, p = 0.012). Married individuals or those living with a partner had a lower risk of depression (Adjusted OR = 0.29, p = 0.018) compared to the reference group (e.g., single/divorced/widowed). Conversely, perceived stigma significantly increased the risk of depression by the highest margin of 5.77 times (p = 0.014). Finally, males were 3.17 times more likely to experience depression than females, a finding that was also statistically significant (p = 0.027).

Conclusion: The findings demonstrate a bi-directional relationship between depression and ART adherence, with each significantly impacting the other. Maintaining consistent medication adherence (≥95%) can reduce the likelihood of developing depression by up to 92%. On the other hand, depression acts as a primary variable that disrupts self-care behaviors, leading to a loss of motivation, hopelessness, or forgetfulness, which ultimately results in medication non-adherence. Furthermore, the high prevalence of depression, affecting nearly 1 in 3 patients (28.66%), reinforces that this is not merely an individual issue but a systemic public health challenge that requires integrated intervention.