Postpartum Depression and Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Kenya

Abstract

Background: The relationship between postpartum depression and prevention of mother-to-child transmission (PMTCT) outcomes within low- and middle-income countries (LMICs) is understudied. Methods: Data were analyzed from a cross-sectional survey of mother-infant pairs attending 6-week and 9-month immunization visits at 141 maternal child health (MCH) clinics across Kenya conducted June-December 2013. Depression was assessed using the Patient Health Questionnaire (PHQ)-9 and defined as a PHQ-9 score >8. We determined prevalence of depression among HIV-infected postpartum mothers and evaluated the association of maternal depression and PMTCT outcomes (uptake of antiretrovirals for PMTCT among mothers and infants, and infant HIV positivity). Results: Among 498 HIV-infected mothers surveyed, median age was 28 years (IQR 24-32) and 17% were unmarried. Overall, 31/498 (6%) of HIV-infected mothers had PHQ-9 scores ≥8; 14/260 (5%) of those attending 6-week visits and 17/238 (7%) attending 9-month visits. Compared to mothers without depression, intimate partner violence was reported more frequently among mothers with depression (12% vs 39%, p<0.001). The likelihood of having an HIV-positive infant was 4-fold higher among women with depression (odds ratio [OR]=3.89, 95% CI 1.24-12.25, p=0.021). Mothers with depression were also more likely to have infants who did not receive ARVs for prophylaxis (13% vs 2%, odds ratio [OR]=6.14, 95% CI 1.76-21.64, p=0.005). We did not detect differences in uptake of maternal ARVs between mothers with and without depression. Conclusions: Depression was associated with increased likelihood of MTCT and lower likelihood of infant receipt of ARV prophylaxis.