Correlates of viral non-suppression among South African antiretroviral therapy users: comorbidity of major depression, posttraumatic stress, and alcohol use disorders

Antiretroviral therapy (ART) users at two public health facilities in South Africa were assessed for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), using the Structured Clinical Interview for the DSM5 (n = 688). Multivariate regression analysis was used to identify associations between mental disorders and unsuppressed viral load (VL), controlling for sociodemographic factors. All main effects and two-way interaction effects between mental disorders were explored. Prevalence estimates for MDD, PTSD and AUD were 24.9%, 14.7% and 22.1%, respectively, and 22.0% had unsuppressed VL. In multivariate regression models, unsuppressed VL was associated with being unemployed (aOR = 2.23) and AUD (aOR = 1.78). MDD, PTSD and comorbid mental disorders did not increase risk of unsuppressed VL. Population Attributable Risk analysis indicated that treating AUD could yield a 2% absolute reduction in prevalence of unsuppressed VL (equivalent to 9.3% proportional reduction), highlighting the importance of screening and treating AUD among persons receiving ART.