How Does Depression Effect Art Adherence In HIV Healthcare?

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Introduction
In HIV care, ART adherence is the extent to which a patient takes their HIV medicine and coincides with a health-provider’s recommendation. The lack of adherence to antiretroviral therapy can result in increased viral resistance, insufficient viral suppression, the progression of AIDS or even death (Al-Dakkak, I, 2013). The health care needed for HIV treatment is life-long as HIV is a chronic disease that can result in many stigma-related barriers to care, and sophisticated treatment regimens which can cause drug interactions or unwanted side effects (Stricker, S. M, 2014). Depression is one side effect consistently found to be associated with non-adherence to ART. Although there are many studies suggesting depressive symptoms
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A RCT found that psychosocial syndemics increased the likelihood of ART non- adherence among HIV patients with an 80% adherence cut-off (Blashill, A. J., Bedoya, C. A.,2015). This study found that over 56% of patients with pyschoscoial syndemics were non-adherent and with any combination of 1 or more syndemics were at greater odds to be non-adherent. This potentially suggests HIV patients with psychosocial syndemics are more likely to have non-adherence and insufficient viral suppression than HIV patients without signs of depression. Some other studies included cross-sectional surveys which found more correlations amongst depressive symptoms and ART adherence rather than causation. One study for instance found that optimal ART adherence depends on social support and mental health status among HIV patients (Huynh, A. K.,2013). Another found that greater depressive symptoms and larger environmental punishment were significantly correlated with a larger number of doses missed across nonadherence (Magidson, J. F., Listhaus, A., 2015). The last cross-sectional found a high correlation of depressive symptoms and emotion dysregulation in connection to ART adherence and HIV symptom side effects, distress tolerance and avoidant coping (Brandt, C. P.,2015). This study along with the other two cross-sectional studies were entirely self-reported data which could have

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