Depression Burden and Medication Non-Adherence Among Transgender Women on PrEP and ART: Findings from a South African National Survey
1
Aurum Institute, Johannesburg, South Africa
2
University of Utrecht, Utrecht, Netherlands
Popul. Med. 2026;8(Supplement Supplement 1):A2570
ABSTRACT
BACKGROUND:
Transgender women (TGW) experience disproportionately high rates of depression and face significant barriers to optimal HIV prevention and treatment outcomes. Depression has been identified as a critical factor affecting medication adherence, yet limited research has examined this relationship specifically among TGW taking pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART). This study examined the relationship between depression severity, as measured by the Patient Health Questionnaire-9 (PHQ-9), and self-reported medication adherence to PrEP or ART among South African TGW.
METHODS:
A cross-sectional national survey was conducted between April and September 2025 with 232 TGW participants across South Africa. Depression severity was assessed using the PHQ-9, categorizing participants into five groups: none- minimal, mild, moderate, moderately severe, and severe depression. Medication adherence was evaluated among participants currently taking PrEP or ART through a questionnaire assessing whether participants had missed medication during the past month. Chi-square tests and binary logistic regression analyses were performed to examine associations between depression categories and adherence patterns.
RESULTS:
Depression prevalence was notably high, with only 11.6% (n=27) reporting minimal symptoms. Distribution across categories showed 31.9% moderate (n=74), 37.0% moderately to severe (n=86). Among 193 participants taking PrEP/ART, 33.7% (n=65) reported missing doses. A statistically significant association was found between depression severity and medication non-adherence (χ² =14.144, df = 4, p = 0.007). Logistic regression revealed that each one-level increase in depression severity was associated with 37.9% increased odds of nonadherence (OR = 1.38, 95% CI: 1.06-1.80, p = 0.018). Compared to minimal depression, severe depression conferred 3.33 times higher odds of non-adherence (OR = 3.33, 95% CI: 1.06-10.53, p = 0.040).
CONCLUSIONS:
The high prevalence of moderate to severe depression (68.9%) and substantial non-adherence among TGW underscore the urgent need for integrated mental health and HIV services, routine depression screening, and adherence interventions addressing mental health challenges.
Transgender women (TGW) experience disproportionately high rates of depression and face significant barriers to optimal HIV prevention and treatment outcomes. Depression has been identified as a critical factor affecting medication adherence, yet limited research has examined this relationship specifically among TGW taking pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART). This study examined the relationship between depression severity, as measured by the Patient Health Questionnaire-9 (PHQ-9), and self-reported medication adherence to PrEP or ART among South African TGW.
METHODS:
A cross-sectional national survey was conducted between April and September 2025 with 232 TGW participants across South Africa. Depression severity was assessed using the PHQ-9, categorizing participants into five groups: none- minimal, mild, moderate, moderately severe, and severe depression. Medication adherence was evaluated among participants currently taking PrEP or ART through a questionnaire assessing whether participants had missed medication during the past month. Chi-square tests and binary logistic regression analyses were performed to examine associations between depression categories and adherence patterns.
RESULTS:
Depression prevalence was notably high, with only 11.6% (n=27) reporting minimal symptoms. Distribution across categories showed 31.9% moderate (n=74), 37.0% moderately to severe (n=86). Among 193 participants taking PrEP/ART, 33.7% (n=65) reported missing doses. A statistically significant association was found between depression severity and medication non-adherence (χ² =14.144, df = 4, p = 0.007). Logistic regression revealed that each one-level increase in depression severity was associated with 37.9% increased odds of nonadherence (OR = 1.38, 95% CI: 1.06-1.80, p = 0.018). Compared to minimal depression, severe depression conferred 3.33 times higher odds of non-adherence (OR = 3.33, 95% CI: 1.06-10.53, p = 0.040).
CONCLUSIONS:
The high prevalence of moderate to severe depression (68.9%) and substantial non-adherence among TGW underscore the urgent need for integrated mental health and HIV services, routine depression screening, and adherence interventions addressing mental health challenges.
| eISSN: | 2654-1459 |
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