(PS3-54) Examining the Longitudinal Effects of Insomnia on Depression and Medication Adherence in People Living with HIV

Objective  

Over the last forty years, HIV has shifted from an acute terminal illness to a chronic illness that can be managed well with antiretroviral therapy (ART) in the form of daily oral medications or, more recently, through bimonthly injections. P<span class="NormalTextRun SCXW221727023 BCX0">oor sleep quality is an aspect of health that often goes unidentified and under treated in people living with HIV, yet sleep disturbances impact physical health, mental health, and overall well-being. People living with HIV have higher rates of disrupted sleep, with studies finding that as many as 30% to 90% of people living with HIV (PLWH) experience sleep disturbances which is significantly more than the general population (10-30%). The current study examines the association between insomnia and depression, as well as its impact on medication adherence over time.

Methods 

Participants were active patients in an urban, public, nonprofit ambulatory care center HIV clinic associated with a large, academic medical center. This study assessed depression (PHQ-9), insomnia (ISI), and medication adherence (Wilson) at baseline, 3-month, and 6-month intervals. Hierarchical linear models were employed to analyze the fixed and random effects of time, within-person and between-person insomnia on depression, as well as the effects of time, within-person and between-person depression on ART adherence. 

Results 

Longitudinal analysis revealed that with each Insomnia Severity Index (ISI) point increase corresponded to a 0.267-point rise in Patient Health Questionnaire-9 (PHQ-9) scores (p< 0.001). Similarly, the between-person effects of insomnia and depression were statistically significant and in the direction anticipated such that for each additional point in the average ISI score of an person over the observation period, they experienced, on average, 0.476 greater points on the PHQ-9 (p< .001). Time was no longer a significant predictor of depression after accounting for the effects of insomnia (p=.146). The within-person effects of depression on adherence were trending toward significance, such that when an individual experienced an increase of 1 point on the PHQ-9 compared to their own average, they also tended to experience lower medication adherence (p=.059). Time was not a significant predictor of medication adherence (p=.411). The between-person effects of depression on adherence were statistically significant, such that each additional point in an individual’s average PHQ-9 score over time was associated with 0.36% lower medication adherence (p=.012). Time was not a significant predictor of medication adherence (p=.411)

Conclusion 

The statistically significant findings for both between and within-person effects of insomnia on depression in our sample of people living with HIV, suggest that these symptoms persist over time without clinical intervention. The study underscores the impact of insomnia on mental health and treatment adherence in PLWH. Integrated interventions targeting sleep disturbances are crucial for improving overall well-being and treatment outcomes, emphasizing the necessity of comprehensive care models considering the interplay between sleep quality, mental health, and medication adherence for PLWH.