Postpartum depression (PPD) is associated with poor maternal and child health outcomes. Few studies have evaluated PPD in women living with HIV (WLHIV) in Botswana, a high prevalence HIV setting.
Using the Edinburgh Postnatal Depression Scale (EPDS), we evaluated PPD symptoms at 2, 6, and 12 months (mo) postpartum in WLHIV and HIV-uninfected (HIV-U) women enrolled in the Tshilo Dikotla cohort study in Botswana. Women scoring ≥10 on the EPDS or reporting thoughts of self-harm were defined as at risk for ongoing PPD symptoms. Secondary outcomes included: EPDS score ≥10, EPDS score ≥13, and EPDS score ≥13 or reporting thoughts of self-harm. Generalized estimating equation models were fit to assess the association of maternal HIV infection with risk of PPD symptoms in the first year postpartum. Subgroup analyses in WLHIV were performed to assess factors associated with risk of PPD symptoms.
Of 321 women enrolled, 195 were WLHIV. WLHIV were older (28.9 vs 24.4 years, p<0.01) with higher gravidity, (3 vs 1, p<0.01) and were less likely to complete tertiary education (7% vs 31%, p<0.01) compared to HIV-U women. Among WLHIV, 45% had a CD4 count >500 cells/mm3 and 93% had an HIV RNA level <40 copies/mL at enrolment; median years since HIV diagnosis was 1.6. All WLHIV received a backbone of tenofovir + emtricitabine and either dolutegravir (DTG) or efavirenz (EFV). At 2, 6, and 12 mo postpartum, 301, 233, and 103 women, respectively, completed the EPDS. At 2 mo, 4 WLHIV and 6 HIV-U met the criteria for being at risk for PPD symptoms. At 6 mo and 12 mo, 6 and 4 WLHIV respectively met the criteria for being at risk for PPD symptoms, whereas no HIV-U women met the criteria. After adjusting for age, gravidity, education level, marital status, and employment, WLHIV were at increased risk for PPD symptoms compared to HIV-U women (adjusted Odds Ratio: 3.37, 95% Confidence Interval: 1.14-10.02). Findings were similar in models evaluating secondary outcomes. (Table 1) Among WLHIV, no associations were seen between age, gravidity, employment, CD4, years with HIV, timing of ART initiation, or ART regimen and PPD symptoms.
Despite overall low rates of PPD symptoms in this small Botswana cohort, WLHIV may be at higher risk for experiencing PPD symptoms in their first year postpartum compared to HIV-U women. Screening WLHIV for PPD symptoms and providing support during the postpartum period are an important part of routine postpartum care for this vulnerable population.