Depression and incident HIV in adolescent girls and young women in HPTN 068: Targets for prevention and mediating factors

Dana E Goin, Rebecca M Pearson, Michelle G Craske, Alan Stein, Audrey Pettifor, Sheri A Lippman, Kathleen Kahn, Torsten B Neilands, Erica L Hamilton, Amanda Selin, Catherine MacPhail, Ryan G Wagner, F Xavier Gomez-Olive, Rhian Twine, James P Hughes, Yaw Agyei, Oliver Laeyendecker, Stephen Tollman, Jennifer Ahern

Research output: Contribution to journalArticle (Academic Journal)

Abstract

The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13 - 21) in rural Mpumalanga Province, South Africa during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and assessed mediation using inverse odds ratio weighting. Inference was calculated using the non-parametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared to those without (risk difference = 3.5 [95% CI 0.1, 7.0]). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6 [95% CI 0.0, 3.3]) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5 [95% CI -0.3, 3.3]). All mediators jointly explained two-thirds (indirect effect = 2.4 [95% CI 0.2, 4.5]) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health may reduce risk of acquiring HIV among AGYW.

Original languageEnglish
Number of pages28
JournalAmerican Journal of Epidemiology
Early online date29 Oct 2019
DOIs
Publication statusE-pub ahead of print - 29 Oct 2019

Keywords

  • depression
  • HIV/AIDS
  • adolescent health
  • South Africa

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    Goin, D. E., Pearson, R. M., Craske, M. G., Stein, A., Pettifor, A., Lippman, S. A., Kahn, K., Neilands, T. B., Hamilton, E. L., Selin, A., MacPhail, C., Wagner, R. G., Gomez-Olive, F. X., Twine, R., Hughes, J. P., Agyei, Y., Laeyendecker, O., Tollman, S., & Ahern, J. (2019). Depression and incident HIV in adolescent girls and young women in HPTN 068: Targets for prevention and mediating factors. American Journal of Epidemiology. https://doi.org/10.1093/aje/kwz238