Depression, pregnancy, and HIV: the case to strengthen mental health services for pregnant and post-partum women in sub-Saharan Africa

Abstract

New science and policy guidance 1 WHOProgrammatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. World Health Organization, Geneva2012 Google Scholar for maternal HIV care and prevention of mother to child transmission of HIV offers—for the first time since the start of the HIV epidemic—a pathway towards an AIDS-free generation. 2 Thyssen A Lange JH Thyssen E Reddi A Toward an AIDS-free generation with option B+: reconceptualizing and integrating prevention of mother to child transmission (PMTCT) with pediatric antiretroviral therapy initiatives. J Acquir Immune Defic Syndr. 2013; 62: 127-128 Crossref PubMed Scopus (10) Google Scholar Antiretroviral regimens are potent, well tolerated, and can extend an essentially normal lifespan to patients who take them as prescribed. If antiretroviral drugs are started at an early stage of pregnancy and continued uninterrupted throughout breastfeeding, the risk of HIV transmission from mother to child decreases to almost zero. 3 Moodley P Parboosing R Moodley D Reduction in perinatal HIV infections in KwaZulu-Natal, South Africa, in the era of more effective prevention of mother to child transmission interventions (2004–2012). J Acquir Immune Defic Syndr. 2013; 63: 410-415 Crossref PubMed Scopus (14) Google Scholar However, in many African settings the promise of these new initiatives is far from fully realised. Health systems are overstretched and underresourced, providers are overworked, and patients have various competing issues, including depressed moods, which prevent them from remaining in care and consistently adhering to their prescribed antiretroviral regimens. Poor adherence to drugs and high losses during follow-up are the two largest threats to the effectiveness of programmes for the prevention of mother-to-child HIV transmission. 4 Stringer EM Ekouevi DK Coetzee D et al. Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries. JAMA. 2010; 304: 293-302 Crossref PubMed Scopus (120) Google Scholar , 5 Stringer JS Stinson K Tih PM et al. Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries. PLoS Med. 2013; 10: e1001424 Crossref PubMed Scopus (24) Google Scholar We argue that perinatal depression is epidemic in many countries and, when untreated, can substantially amplify both of these threats. Identification of and treatment for perinatal depression is essential to maintain the hard-won gains recently made in the expansion of perinatal HIV/AIDS services in sub-Saharan Africa.