ArticleAIDS and behavior2020
The Effect of Depression on Adherence to HIV Pre-exposure Prophylaxis Among High-Risk South African Women in HPTN 067/ADAPT.
Article in AIDS and behavior, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Strategies to Improve PrEP Adherence in People Who Use Drugs: A Systematic Review.AIDS and behavior · 2026Pooled it
- Interventions and Strategies to Increase Cervical Cancer Screening, Treatment, and Retention in Care among Persons with HIV in Low- and Middle-Income Countries: A Systematic Review.AIDS and behavior · 2025Pooled it
- Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men: A Systematic Review and Meta-analysis.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2024Pooled it
- Acceptability of an Integrated Model of Mental Health and PrEP Service Delivery for South African Adolescent Girls: Qualitative Results from a Pilot Hybrid Effectiveness-Implementation Randomized Trial.AIDS and behavior · 2026Trial
- Combining HIV prevention Options with Mental health service delivery for Adolescent girls and young women (CHOMA): results of a pilot hybrid effectiveness-implementation randomized trial in South Africa.Journal of the International AIDS Society · 2025Trial
- Understanding barriers and facilitators to doxycycline post-exposure prophylaxis adherence among young women in western kenya: a qualitative study.BMC infectious diseases · 2025Trial
- Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre-exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial.Journal of the International AIDS Society · 2021Trial
- "If I'm Not Okay, I Won't Take the Pills": Anticipating the Effects of Depression and PTSD on PrEP Use Among PrEP Naïve Pregnant and Postpartum Persons in South Africa.International journal of behavioral medicine · 2026Article
- Article
- HIV Diagnosis and Preexposure Prophylaxis (PrEP) Prescription Among Commercially Insured Persons With Bipolar Disorder.The Journal of clinical psychiatry · 2025Article
- Interpersonal factors associated with depression symptom severity among PrEP-naïve pregnant women in South Africa: a mixed-methods analysis.AIDS care · 2025Article
- High Retention and Adherence With Rapid Long-acting Injectable Preexposure Prophylaxis Implementation in an Urban Safety Net Clinic Population.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- The Impacts of Substance Use and Depression on HIV Pre-Exposure Prophylaxis Use and Adherence Among Sexual and Gender Minority Adolescents and Young Adults in the Keeping it LITE Cohort.AIDS and behavior · 2025Article
- Adolescents' and young women's perspectives on participation in biomedical clinical trials for HIV prevention in Tanzania and India: A qualitative inquiry.Vulnerable children and youth studies · 2025Article
- Article
- Integrating a mental health intervention into PrEP services for South African young women: a human-centred implementation research approach to intervention development.Journal of the International AIDS Society · 2024Article
- Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model.Brain and behavior · 2024Article
- An Open Letter on Advancing HIV prevention: Augmenting an ecosystem-based approach to understand prevention decision-making.Gates open research · 2024Article
- Depression and HIV Care-seeking Behaviors in a Population-based Sample in North West Province, South Africa.AIDS and behavior · 2023Article
- Depression and PrEP uptake, interruption, and adherence among young women in Uganda.AIDS care · 2023Article
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
Abstract
Oral pre-exposure prophylaxis (PrEP) is highly efficacious but low adherence undermines effectiveness. Depression, common in African women, may be a barrier to consistent PrEP use. We aimed to assess the relationship between depression, psychosocial mediators, and PrEP adherence among South African women. We analyzed data from 174 South African women in HPTN 067, an open-label oral PrEP trial conducted from 2011 to 2013. Participants were followed for 24 weeks. PrEP adherence was measured via Wisepill™ and weekly self-report interview data. We considered participants "adherent" at week 24 if Wisepill™ and interviews indicated that ≥ 80% of expected doses were taken in the prior month. Elevated depressive symptoms were assessed using the 20-item Center for Epidemiological Studies-Depression (CES-D) scale. We used marginal structural models to estimate the effect of elevated symptoms at baseline on PrEP adherence at week 24 and to assess whether the direct effect changed meaningfully after accounting for mediating effects of stigma, social support, and PrEP optimism. High PrEP adherence occurred less often among women with elevated depressive symptoms (N = 35; 44.3%) compared with those without (N = 52; 54.7%; adjusted relative risk [aRR]: 0.79; 95% confidence interval [CI] 0.63-0.99). The effect of elevated depressive symptoms on PrEP adherence persisted in models accounting for the mediating influence of stigma (aRR: 0.74; 95% CI 0.51-0.97) and PrEP optimism (aRR: 0.75; 95% CI 0.55-0.99). We also found a direct effect of similar magnitude and direction when accounting for social support as the mediating variable, although this adjusted relative risk estimate was not statistically significant (aRR: 0.77; 95% CI 0.57-1.03). Depressive symptoms were common and associated with lower PrEP adherence among South African women. Future work is needed to determine whether depression services integrated with PrEP delivery could improve PrEP effectiveness among African women.
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Registered trials
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