Clinician-Assessed Depression and HAART Adherence in HIV-Infected Individuals in Methadone Maintenance Treatment

Abstract

The impact of measurement methods on the relationship between depression and HIV treatment adherence has not been adequately examined. The purpose of this paper is to examine the relationship between clinician- and patient-rated depression and HIV medication adherence. The participants were 91 HIV-infected individuals in methadone maintenance. Depression was assessed via clinician ratings (Clinical Global Impression Scale and Montgomery Asberg Depression Rating Scale) and self-report (Beck Depression Inventory-Short Form). Clinicians rated substance abuse using the Clinical Global Impression Scale and a structured interview. HIV medication adherence was measured over the following 2 weeks using electronic caps. Each unit increase in the Clinical Global Impression Scale was associated with 75% increased odds of nonadherence (OR=1.75, p=0.002, 95% CI=1.23-2.48). Similarly, for each standard deviation Montgomery Asberg Depression Rating Scale increase, there was a 2.6-fold increased odds of nonadherence (OR=2.60, p=0.001, 95% CI=1.45-4.67). Substance abuse and self-reported depression severity were not significantly related to adherence. Clinician-rated depression severity was a strong predictor of nonadherence. Assessment methods may influence the relationship between depression and HIV nonadherence.