Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

AIDS Behav. 2021 Mar;25(3):826-835. doi: 10.1007/s10461-020-03041-7. Epub 2020 Sep 24.


As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes-retention in HIV care and viral suppression-is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

Keywords: Depression; HIV; Retention; Sub-saharan africa; Viral suppression.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Delivery of Health Care
  • Depression / epidemiology*
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / psychology*
  • Humans
  • Malawi / epidemiology
  • Male
  • Medication Adherence / statistics & numerical data*
  • Retention in Care*
  • Sustained Virologic Response
  • Viral Load / drug effects*


  • Anti-HIV Agents