Browsing by Author "Mocello, A. Rain"

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    Declining Prevalence of Probable Depression Among Patients Presenting for Antiretroviral Therapy in Rural Uganda: The Role of Early Treatment Initiation
    (AIDS and Behavior, 2015) Chan, Brian T.; Weiser, Sheri D.; Boum, Yap; Haberer, Jessica E.; Kembabazi, Annet; Hunt, Peter W.; Martin, Jeffrey N.; Mocello, A. Rain; Bangsberg, David R.; Tsai, Alexander C.
    Little is known about trends in depression at antiretroviral therapy (ART) initiation among people living with HIV (PLHIV) in low- and middle-income countries. We used data from an ongoing cohort of treatment -naı¨ve PLHIV in rural Uganda to estimate secular trends in depression among PLHIV at ART initiation. We fitted linear regression models with depression symptom severity as the outcome variable and year of cohort entry (2005–2012) as the explanatory variable, adjusting for socio-demographic variables and assessing physical health score, body mass index (BMI), and CD4 count as potential mediators of a secular trend in depression symptom severity. There was a statistically significant negative association between year of entry and depression symptom severity, suggesting a 3.1 % relative decline in the mean depression symptom severity score at ART initiation in each year of study recruitment after the first year. This trend remained statistically significant after inclusion of baseline socio demographic characteristics to the model and appeared to be driven by improved physical health scores, but not CD4 count or BMI.
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    Depression and All-Cause Mortality in an HIV Treatment Cohort in Rural Uganda!
    (U.S. National Institutes of Health, 2005) Tsai, Alexander; Chan, Brian; Yap, Boum; Jessica, Haberer; Kembabazi, Annet; Mocello, A. Rain; Hunt, Peter; Martin, Jeffrey; Bangsberg, David
    To determine the extent to which depression is associated with mortality among persons living with HIV (PLHIV) initiating antiretroviral therapy (ART).! 694 treatment-naïve PLHIV in rural Uganda were followed from initiation of ART. Each participant provided quarterly data through blood draws and structured interviews. Baseline depression symptom severity and mental health status were measured using locally adapted versions of the Hopkins Symptom Checklist and MOS-HIV mental health summary. Vital status was ascertained through participant tracing after missed study visits. We fit Cox proportional hazards regression models, adjusting our estimates for baseline age, sex, marital status, educational attainment, household asset wealth, CD4+ T-lymphocyte cell count, body mass index, and MOS-HIV physical health summary.! Over 4.3 median years of follow-up, only 48 participants (7%) were lost to follow-up and there were 44 deaths. After multivariable adjustment, probable depression was associated with increased mortality (AHR=2.24; 95% CI, 1.08-4.62), while mental health-related quality of life was not (AHR=0.98; 95% CI, 0.94-1.03).! Conclusions: Depressed mood is associated with increased mortality among HIV+ persons initiating ART. Screening for depression may be a relatively low-cost method of identifying HIV+ persons at high risk for mortality. Whether pre-ART depression reflects underlying immune activation or poor overall health status should be addressed in future studies.!
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    HIV-infected women on antiretroviral treatment have increased mortality during pregnant and postpartum periods
    (AIDS (London, England), 2013) Matthews, Lynn T.; Kaida, Angela; Kanters, Steven; Byakwagamd, Helen; Mocello, A. Rain; Muzoora, Conrad; Kembabazi, Annet; Haberer, Jessica E.; Martin, Jeffrey N.; Bangsberg, David R.; Hunt, Peter W.
    To assess the impact of pregnancy on mortality among HIV-infected Ugandan women initiating ART. Prospective cohort study. HIV-infected women initiating ART in the Uganda AIDS Rural Treatment Outcomes study were assessed quarterly for self-reported pregnancy. The association between pregnancy and postpartum (‘pregnancy-related’) follow-up periods and mortality was assessed with Cox proportional hazards models adjusted for age, CD4 cell count, plasma HIV-1 RNA levels, and ART duration. Results: Three hundred and fifty-four women with median age 33 years (IQR: 27–37) and CD4 142 cells/ml (IQR: 82–213) were followed for a median of 4.0 years (IQR: 2.5–4.8) after ART initiation, with 3 and 7% loss-to-follow-up at years 1 and 5. One hundred and nine women experienced pregnancy. Five deaths occurred during pregnancy-related follow-up and 16 during nonpregnancy-related follow-up, for crude mortality rates during the first year after ART initiation of 12.57/100 PYs and 3.53/100 PYs (rate ratio 3.56, 95% CI: 0.97–11.07). In adjusted models, the impact of pregnancy related follow-up on mortality was highest at ART initiation (aHR: 21.48, 95% CI: 3.73–123.51), decreasing to 13.44 (95% CI 3.28–55.11) after 4 months, 8.28 (95% CI 2.38–28.88) after 8 months, 5.18 (95% CI: 1.36–19.71) after 1 year, and 1.25 (95% CI: 0.10–15.58) after 2 years on ART. Four of five maternal deaths occurred postpartum.