The relationship between depression, HIV-stigma and adherence to ART among adult patients living with HIV at tertiary Hospital in Durban, South Africa: the mediating roles of self-efficacy and social support

Abstract

BACKGROUND: Although, numerous factors predicting adherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWH) have been broadly studied on both regional and global level, up-to-date adherence of patients to ART remains an overarching, dynamic and multifaceted problem that needs to be investigated overtime and across various contexts. There is a dearth of empirical studies on the interactive mechanism by psychosocial factors predict adherence to ART among PLWH in South Africa. This study investigated the relationship between depression, HIV-stigma, and adherence to ART among adult patients living with HIV at a tertiary Hospital in Durban, South Africa and the mediating role of self-efficacy and social support.METHODS: A total of 201 male and female adult patients aged between 18-75 years receiving ART at King Edward VIII Hospital's ARV clinic were sampled, using time location sampling (TLS) and data were collected using self-administered questionnaire. Guided by Health Locus of Control Theory and Social Support Theory, data were analysed using SPSS through bivariate, logistic regression and mediational analyses.RESULTS: Chi-square analysis showed that there was a statistically significant difference found between depression and ART adherence (Ï?2 (4) = 16.140; p < .003), while between HIV stigma and ART adherence no statistically significant difference was found (Ï?2 (1) = .323; p >.570). Binary logistic regression indicated that depression was statistically associated with adherence to ART (OR= .853; 95% CI, .789'.922, P 0.31). However, the findings showed that the effect of depression on adherence to ART was not significantly mediated by self-efficacy (Sobel test for indirect effect, Z= 1.01, P> 0.31). The effect of HIV stigma on adherence to ART was not statistically significant (OR= .980; 95% CI, .937' 1.025, P>.374), but the effect of social support on adherence to ART was statistically significant, only after the effect of HIV stigma was controlled for (OR= 1.017; 95% CI, 1.000' 1.035, P<.046).CONCLUSIONS: The results revealed that depression is a significant predictor of adherence to ART. Thus, the findings also suggested that in effort to alleviate the psychosocial impact of depression on adherence to ART, a special consideration of self-efficacy and social support should be taken into consideration.