Clinician-assessed depression and HAART adherence in HIV-infected individuals in methadone maintenance treatment

Abstract

Background: The impact of measurement methods on the relationship between depression and HIV treatment adherence has not been adequately examined. Purpose: The purpose of this paper is to examine the relationship between clinician- and patient-rated depression and HIV medication adherence. Methods: 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. Results: 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. Conclusions: Clinician-rated depression severity was a strong predictor of nonadherence. Assessment methods may influence the relationship between depression and HIV nonadherence. © 2011 The Society of Behavioral Medicine.