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

AIDS. 2018 Nov 28;32(18):2827-2833. 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Depression / epidemiology*
  • Facilities and Services Utilization / statistics & numerical data*
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • Humans
  • Malawi
  • Medication Adherence
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Prevalence
  • Prospective Studies
  • Sustained Virologic Response*
  • Young Adult


  • Anti-Retroviral Agents