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Magnolini R, Staehelin S, Senkoro E, Kruijver M, Krinke E, Weisser M. Effectiveness and acceptance of group therapy as a mental health intervention for people living with HIV in Africa - a scoping literature review. AIDS Care 2024; 36:870-884. [PMID: 38289672 DOI: 10.1080/09540121.2023.2298779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/18/2023] [Indexed: 07/25/2024]
Abstract
Mental health problems are highly prevalent among people living with HIV/AIDS (PLWHA), yet mental health care in African countries is scarce. There is growing interest in understanding the effect of group therapy delivery models and task-shifting to support mental health care in African settings. We conducted a scoping review following the PRISMA-ScR statement on group therapy in PLWHA in Africa. We searched PubMed/Medline, Embase, and Google Scholar for articles published before October 2023 on evidence for effectiveness and acceptance of group therapies in PLWHA, and evidence of task-shifting approaches. A narrative synthesis approach for data analysis was used. We included 17 studies, which comprised 26 different outcome measures across seven countries in sub-Sahara Africa. The majority (72%) of the assessed single outcomes demonstrated a positive impact of group therapy delivery models on outcome measures, particularly depression, alcohol use, overall functioning, and social support in sub-Sahara Africa. High acceptance was demonstrated by quantitative and qualitative approaches. Task shifting approaches generally were shown to be effective, cost-effective, and accepted, and may support burdened healthcare systems in rural settings. The current evidence, albeit scarce, supports the use of group therapy and task shifting in addressing mental health among PLWHA living in sub-Sahara Africa.
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Affiliation(s)
| | - Sarah Staehelin
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Muriel Kruijver
- Department of Human Medicine, University of Zurich, Zurich, Switzerland
| | - Eileen Krinke
- Clinic for Adults, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Maja Weisser
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
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Wong CPS, Yeung JTK, Fong DYT, Smith RD, Ngan AHY, Lam YYL, Chan KSS, Leung HHY, Wang MP, Wong JYH. Effectiveness of group cognitive behavioral therapy for depression in adults: a systematic review and meta-analysis of delivery by different healthcare professionals. Cogn Behav Ther 2024; 53:302-323. [PMID: 38372166 DOI: 10.1080/16506073.2024.2313741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/14/2024] [Indexed: 02/20/2024]
Abstract
This study addresses the gap in understanding the varied effectiveness of group cognitive behavioral therapy (gCBT) delivered by different professionals. This study aims to address this gap by conducting a systematic review of randomized controlled trials (RCTs) that evaluate gCBT and compare it to inactive controls in adults with a clinical diagnosis of depression. A total of 33 RCTs were included for analysis. In the overall analysis, 'profession of gCBT deliverer' was not a significant moderator in the meta-regression model (p = 0.57). For people without comorbidity, the overall effect size estimate was -0.69 (95% CI, -1.01. to -0.37, p = 0.03). Among gCBT deliverers, psychologists and nurses/psychiatric nurses demonstrated significant effectiveness, with psychologists showing a large effect size of -0.78 (95% CI, -1.25 to -0.30, p < 0.01) and nurses/psychiatric nurses showing a medium effect size of -0.45 (95% CI, -0.85 to -0.05, p = 0.03). The certainty of evidence for both professionals was moderate. These results have significant implications for the delivery of mental healthcare, as nurses/psychiatric nurses may be more accessible and cost-effective than psychologists in some settings. However, further research is necessary to determine the effectiveness of gCBT delivered by a broader range of healthcare professionals for patients with depression and other comorbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Hong Kong, SAR, China
| | - Janet Yuen Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
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Nutor JJ, Gyamerah AO, Duah HO, Asakitogum DA, Thompson RGA, Alhassan RK, Hamilton A. The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002994. [PMID: 38422060 PMCID: PMC10903797 DOI: 10.1371/journal.pgph.0002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Stigma and discrimination have been identified as significant barriers to HIV treatment among people living with HIV (PLWH). HIV stigma affects decision to seek HIV testing and early treatment. Evidence shows that HIV stigma undermines antiretroviral therapy (ART) adherence by affecting the psychological process such as adjusting and coping with social support. In Ghana, stigma toward PLWH occurs in many ways including rejection by their communities and family members, ostracism, and refusal to engage in social interactions such as eating, sharing a bed, or shaking hands. Therefore. we examined PLWH's experiences with different forms of HIV-related stigma and the impact on HIV treatment outcome in the Volta region of Ghana. We employed a convergent mixed-method approach consisting of a survey with 181 PLWH, four focus group discussions with 24 survey respondents, and in-depth interviews with six providers. We performed independent samples t-test, ANOVA, and chi-square test to test associations in bivariate analysis and analyzed qualitative data using thematic analysis. In all, 49% of survey respondents reported experiencing high internalized stigma, which was associated with high social support and depression (p<0.001). In qualitative interviews, anticipated stigma was the most salient concern of PLWH, followed by internalized and enacted stigma, which all negatively impacted HIV treatment and care. Stigma was experienced on multiple levels and affected psychosocial and treatment outcomes. Findings suggest urgent need for HIV-stigma reduction intervention among PLWH and their family, providers, and community members.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Akua O. Gyamerah
- Department of Community Health and Health Behavior, University of Buffalo, Buffalo, New York, United States of America
| | - Henry Ofori Duah
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - David Ayangba Asakitogum
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Rachel G. A. Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Alison Hamilton
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
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Bernard C, Mané I, Ziadeh S, Tine JM, Diaw A, Benzekri N, Ndiaye I, Samba O, Font H, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Perceptions, facilitators and barriers to the implementation of interpersonal group therapy to treat depression among people living with HIV in Senegal: a qualitative study. Front Public Health 2024; 12:1295181. [PMID: 38327573 PMCID: PMC10848853 DOI: 10.3389/fpubh.2024.1295181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Background Depression is highly prevalent in people living with HIV (PLWH) but remains under treated in Sub-Saharan Africa. In this context, we conducted the first study of Group Interpersonal Therapy (IPT) to treat depression in PLWH in Senegal. We assessed the perceptions and experiences of patients and group facilitators, as well as barriers to implementation. Methods This study was conducted at the Fann National University Hospital Center in Dakar, the urban capital of Senegal. Qualitative data were collected during the implementation phase (February to June 2020 and then from January to February 2021), with a 6-month pause due to the COVID-19 pandemic. Twenty-five patients and three group facilitators were individually interviewed by a socio-anthropologist. Qualitative data were analyzed thematically. Results Group IPT was perceived as successful and beneficial by patients and facilitators. Patients reported positive experiences with group IPT and sustained outcomes. Beyond improving depressive symptoms, patients reported improvements in their social and professional lives, and the development of skills to prevent relapse. Group facilitators noted the benefits of therapy for their patients and for their professional skills, reporting greater clinical competence and improved supportive skills. Challenges to intervention implementation included confidentiality and patient privacy concerns, healthcare accessibility issues, and time demands. Conclusion In this first qualitative study of group IPT for depression in PLWH in Senegal, participants described both positive experiences with the intervention and challenges to its implementation. Future studies, conducted in suburban and rural communities outside of Dakar, would further inform the implementation of IPT in Senegal.
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Affiliation(s)
- Charlotte Bernard
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Idrissa Mané
- CNRS, Université de Pau et des Pays de l’Adour, Pau, France
| | - Salaheddine Ziadeh
- Université Libanaise, Faculté de Santé Publique, Sidon, Lebanon
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - Abibatou Diaw
- Centre de Traitement ambulatoire, CHNU de Fann, Dakar, Senegal
| | - Noëlle Benzekri
- Department of Medicine-Infectious Diseases, University of Washington, Seattle, WA, United States
| | | | - Oumar Samba
- Service de psychiatrie, CHNU de Fann, Dakar, Senegal
| | - Hélène Font
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | | | | | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - François Dabis
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Moussa Seydi
- Service des maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
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Jiang YS, Liu TH, Qin D, Wang ZP, He XY, Chen YN. Effects of non-pharmacological interventions on youth with internet addiction: a systematic review and meta-analysis of randomized controlled trials. Front Psychiatry 2024; 14:1327200. [PMID: 38274427 PMCID: PMC10808612 DOI: 10.3389/fpsyt.2023.1327200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Objective To assess the overall effectiveness of non-pharmacological interventions on internet addiction (IA) in youth. Method Randomized controlled trials (RCTs) published from their inception to April 1, 2023 were searched in Cochrane, Embase, Medline, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese BioMedical Literature Database, and WanFang Data. Two reviewers independently extracted data and evaluated bias using the Cochrane Risk of Bias tool. Results Sixty-six studies performed from 2007 to 2023, with a total of 4,385 participants, were identified. The NPIs included group counseling, cognitive behavioral therapy, sports intervention, combined interventions, eHealth, educational intervention, positive psychology intervention, sand play intervention, and electrotherapy. The results revealed that NPIs significantly reduced IA levels (standardized mean difference, SMD: -2.01, 95% confidence interval, CI: -2.29 to -1.73, I2 = 93.0%), anxiety levels (SMD: -1.07, 95%CI: -1.41 to -0.73, I2 = 72.4%), depression levels (SMD: -1.11, 95%CI: -1.52 to -0.7, I2 = 84.3%), and SCL-90 (SMD: -0.75, 95%CI: -0.97 to -0.54, I2 = 27.7%). Subgroup analysis stratified by intervention measure showed that cognitive behavioral therapy, group counseling, sports intervention, combined intervention, educational intervention, positive psychology intervention, sandplay intervention, and mobile health were all effective in relieving symptoms of IA except electrotherapy. Conclusion NPIs appear to be effective in the treatment of IA in youth, which would act as an alternative treatment of IA. Further studies with larger sample sizes and robust designs are needed.
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Affiliation(s)
- Yue-Shuai Jiang
- School of Sports Management and Communication, Capital University of Physical Education and Sports, Beijing, China
| | | | - Dan Qin
- School of Sports Management and Communication, Capital University of Physical Education and Sports, Beijing, China
| | - Zi-Pu Wang
- School of Sports Management and Communication, Capital University of Physical Education and Sports, Beijing, China
| | - Xiao-Ya He
- School of Sports Management and Communication, Capital University of Physical Education and Sports, Beijing, China
| | - Yan-Nan Chen
- Beijing Normal University, College of P.E. and Sports, Beijing, China
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Park S, Cubillos L, Martinez-Camblor P, Bartels SM, Torrey WC, John DT, Cepeda M, Bell K, Castro S, Suárez-Obando F, Uribe-Restrepo JM, Gómez-Restrepo C, Marsch LA. Integrating Depression and Alcohol Use Care Into Primary Care in Low- and Middle-Income Countries: A Meta-Analysis. Psychiatr Serv 2023; 74:950-962. [PMID: 36852551 DOI: 10.1176/appi.ps.20220267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The study updates a previous systematic review summarizing research on care integration in LMICs. METHODS Following PRISMA guidelines, the authors included studies from the previous review and studies published from 2017 to 2020 that included adults with alcohol use disorder or depression. Studies were evaluated for type of integration model with the typology developed previously. A meta-analysis using a random-effects model to assess effectiveness of integrated interventions was conducted. Meta-regression analyses to examine the impact of study characteristics on depression and alcohol use disorder outcomes were conducted. RESULTS In total, 49 new articles were identified, and 74 articles from the previous and current studies met inclusion criteria for the meta-analysis. Overall random effect sizes were 0.28 (95% CI=0.22-0.35) and 0.17 (95% CI=0.11-0.24) for studies targeting care integration for depression or for alcohol use disorder, respectively, into primary care in LMICs. High heterogeneity within and among studies was observed. No significant association was found between country income level and depression and alcohol use outcomes. However, differences in effect sizes between types of integration model were statistically significant (p<0.001). CONCLUSIONS Integration of mental health care into primary health care in LMICs was found to improve depression and alcohol use disorder outcomes. This evidence should be considered when designing interventions to improve mental health screening and treatment in LMICs.
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Affiliation(s)
- Sena Park
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez-Camblor
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sophia M Bartels
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - William C Torrey
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Deepak T John
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
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Bernard C, Font H, Ziadeh S, Tine JM, Diaw A, Ndiaye I, Samba O, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Management of depression in people living with HIV/AIDS in Senegal: Acceptability, feasibility and benefits of group interpersonal therapy. Glob Ment Health (Camb) 2023; 10:e36. [PMID: 37854409 PMCID: PMC10579691 DOI: 10.1017/gmh.2023.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 10/20/2023] Open
Abstract
Depression is highly prevalent in people living with HIV (PLWH) and has negative consequences for daily life and care. We evaluated for the first time the acceptability, feasibility and benefits of group interpersonal therapy (IPT), combined with a task-shifting approach, to treat depression in PLWH in Senegal. PLWH with depression received group IPT following the World Health Organization protocol. Acceptability and feasibility criteria were defined from the literature data. The PHQ-9, the WHODAS, and the 12-item-stigma scale were used, pre- and post-treatment, including a 3-month follow-up, to assess depressive symptom severity, functioning and stigma, respectively. General linear mixed models were used to describe changes in outcomes over time. Of 69 participants, 60 completed group IPT. Refusal to enroll and dropout rates were 6.6 and 12.7%, respectively. Ninety-seven percent of participants attended at least seven out of eight sessions. Patients and facilitators endorsed group IPT, with willingness to recommend it. Depressive symptoms and disability improved drastically and sustainably. We showed that group IPT is well accepted and feasible in Senegal as treatment for depression in PLWH. Combined with a task-shifting approach, it can narrow the gap in mental health treatment. Implementation may be enhanced by refining patient identification procedures and increasing treatment accessibility.
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Affiliation(s)
- Charlotte Bernard
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Hélène Font
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Salaheddine Ziadeh
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
- Faculté de Santé Publique, Université Libanaise, Sidon, Lebanon
| | - Judicaël M. Tine
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
| | - Abibatou Diaw
- Centre de Traitement Ambulatoire, CHNU de Fann, Dakar, Senegal
| | | | - Oumar Samba
- Service de Psychiatrie, CHNU de Fann, Dakar, Senegal
| | | | | | - Helena Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Ndeye F. Ngom
- Centre de Traitement Ambulatoire, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
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Nakimuli-Mpungu E, Wamala K, Nalugya JS, Nakanyike C, Iya J, Bakeera Kitaka S, Diana Namuli J, Akimana B, Nachega JB, Mills EJ, Seggane M. The effect of group support psychotherapy on adherence to anti-retroviral therapy and viral suppression among HIV positive young people: Study protocol for a pilot randomized controlled trial. FRONTIERS IN HEALTH SERVICES 2023; 3:1011898. [PMID: 37089453 PMCID: PMC10115161 DOI: 10.3389/frhs.2023.1011898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
BackgroundSeveral studies have demonstrated an association between psychological risk factors and HIV disease progression. However, there is limited information on the use of psychological interventions to improve HIV treatment outcomes in young people living with HIV.ObjectiveThis pilot trial aims to evaluate the feasibility, acceptability and preliminary effectiveness of group support psychotherapy in improving adherence to anti-retroviral therapy and viral suppression in young people living with HIV in Uganda.MethodsWe recruited 120 young people with HIV, aged 10–18 years, who had non-viral suppression 6 months after initiating first-line anti-retroviral therapy (ART) from community based HIV clinics in Kitgum district, northern Uganda. Participants were randomly assigned to receive GSP plus IAC (N = 60) or IAC alone (N = 60). Primary outcomes will be indicators of feasibility and acceptability as well as preliminary effectiveness of GSP in improving ART adherence and viral suppression analysed by intention to treat using cluster-adjusted t tests and permutation tests. Secondary outcomes will be measures of depression, anxiety and cost-effectiveness.ResultsThe trial has been approved by the Makerere College of Health Sciences School of Health Sciences Research Ethics Committee, and the Uganda National Council of Science and Technology. Recruitment began in June 2021 and 120 young people living with HIV with their adult caregivers have been recruited to the trial. An analysis of baseline and 6-month data is in progress. The results of this trial will not only be presented at national and international conferences but also submitted for publication in peer-reviewed journals and as a report to the funding agencies.ConclusionsThis pilot trial will provide critical evidence to support the ongoing mental health integration into routine HIV care in Uganda.Trial RegistrationPan African Clinical Trials Registry (PACTR): 202006601935462
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Affiliation(s)
- Etheldreda Nakimuli-Mpungu
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Paediatrics and Childhealth, MakCHS, SEEK Group Support Psychotherapy Initiative Limited, Kampala, Uganda
- Correspondence: Etheldreda Nakimuli-Mpungu
| | - Kizito Wamala
- Department of Psychology, Center for Victims of Torture, Gulu, Uganda
| | | | - Caroline Nakanyike
- Department of Paediatrics and Childhealth, MakCHS, SEEK Group Support Psychotherapy Initiative Limited, Kampala, Uganda
| | - Jane Iya
- Department of Paediatrics and Childhealth, MakCHS, SEEK Group Support Psychotherapy Initiative Limited, Kampala, Uganda
| | - Sabrina Bakeera Kitaka
- Department of Pediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justine Diana Namuli
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Benedict Akimana
- Butabika National Referral Mental Hospital, Ministry of Health of Uganda, Kampala, Uganda
| | - Jean B. Nachega
- Departments of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Center for Infectious Disease, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Departments of International Health and Epidemiology, Bloomberg’s School of Public Health, Johns Hopkins University, Kampala, Uganda
| | - Edward J. Mills
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Musisi Seggane
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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9
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Bhattacharya S, Kennedy M, Miguel C, Tröger A, Hofmann SG, Cuijpers P. Effect of psychotherapy for adult depression on self-esteem: A systematic review and meta-analysis. J Affect Disord 2023; 325:572-581. [PMID: 36642316 DOI: 10.1016/j.jad.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based interventions. To examine this, we had two main aims; (1) to meta-analyze psychotherapy effects on (i) depression and (ii) self-esteem, and (2) to investigate the relationship between reductions in depression symptoms and improvements in self-esteem. DESIGN A systematic review and meta-analysis. METHODS Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of psychotherapy for adult depression, which included a self-esteem outcome at post-treatment. Nineteen studies with a total of 3423 participants met the inclusion criteria. For each comparison between psychotherapy and a control condition, we calculated Hedges' g both for depression and self-esteem and pooled them in two separate meta-analyses. Furthermore, meta-regression was used to explore the association between the effect of psychotherapy for depression and its effect on self-esteem. RESULTS The effects on depression were large and significant (Hedges' g = -0.95; [95 % CI: -1.27, -0.63]). We found evidence of smaller, albeit still moderate, effects on self-esteem (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with sustained effects at 6-12 months (Hedges'g = 0.70; [95 % CI: -0.03, 1.43]). We also found a strong inverse association between the effects of psychotherapy for depression and self-esteem (β = -0.60, p < 0.001). LIMITATIONS Heterogeneity was very high (I2 = 97 %), and out of 19 trials, only 6 trials were rated as having a low risk of bias. CONCLUSIONS The results suggest that psychotherapy for depression may improve self-esteem to a moderate degree.
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Affiliation(s)
- Shalini Bhattacharya
- Institute of Psychiatry, Psychology & Neuroscience - King's College London, United Kingdom.
| | - Mark Kennedy
- Institute of Psychiatry, Psychology & Neuroscience - King's College London, United Kingdom
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Anna Tröger
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps-University Marburg, Germany; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
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10
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Birabwa-Oketcho H, Nakasujja N, Alinaitwe R, Bird V, Priebe S, Sewankambo N. The effectiveness of a solution-focused approach (DIALOG+) for patients with severe mental illness and epilepsy in Uganda: A randomised controlled trial. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:None. [PMID: 36911535 PMCID: PMC9995275 DOI: 10.1016/j.psycom.2022.100097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/22/2022] [Accepted: 12/18/2022] [Indexed: 06/18/2023]
Abstract
A patient centred, solution-focused approach, DIALOG+ was assessed for effectiveness among patients with severe mental illness (SMI) and epilepsy in Uganda. Fourteen clinicians and 168 patients attending Butabika National Mental Referral Hospital and outreach clinics in Kampala, Uganda were randomised equally to receive DIALOG + once a month for six months or an active control (DIALOG scale only). The primary outcome was subjective quality of life measured by the Manchester Short Assessment of Quality of life (MANSA) at six months and secondary outcomes assessed at six and twelve months. A generalised linear model with a fixed effect for treatment and the baseline MANSA score and a random effect for clinicians to account for clustering was used to analyse effectiveness of the intervention. The primary outcome was assessed in 154 out of 168 patients (91.7%). Patients in the DIALOG + arm had significantly higher subjective quality of life with a medium Cohen's d effect size of 0.55 and higher adherence to medication after 6 months as compared to the control group. DIALOG + intervention could be a therapeutically effective option for improving quality of life for patients with severe mental illness and epilepsy with the potential to enhance routine review meetings in low-resource settings.
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Affiliation(s)
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Bird
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Nelson Sewankambo
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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11
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Comparative efficacy and acceptability of non-pharmacological interventions for depression in people living with HIV: A systematic review and network meta-analysis. Int J Nurs Stud 2023; 140:104452. [PMID: 36821952 DOI: 10.1016/j.ijnurstu.2023.104452] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it remains unclear which non-pharmacological treatment is the most effective and acceptable for depression in people living with HIV. OBJECTIVE To compare and rank the efficacy and acceptability of different non-pharmacological treatments for depression in people living with HIV. DESIGN A systematic review and Bayesian network meta-analysis. METHODS We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, PsycArticles, CINAHL, ProQuest, OpenGrey, and international trial registers for published and unpublished studies from their inception to September 1, 2022, and searched key conference proceedings from January 1, 2020, to September 25, 2022. We searched for randomized controlled trials of any non-pharmacological treatments for depression in adults living with HIV (≥18 years old). Primary outcomes were efficacy (mean change scores in depression) and acceptability (all-cause discontinuation). We used a random-effects network meta-analysis model to synthesize all available evidence. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. We registered this study in PROSPERO, number CRD42021244230. RESULTS A total of 53 randomized controlled trials were included in this network meta-analysis involving seven non-pharmacological treatments for depression in people living with HIV. For efficacy, mind-body therapy, interpersonal psychotherapy, cognitive-behavioral therapy, supportive therapy, and education were significantly more effective than most control conditions (standardized mean differences ranged from -0.96 to -0.36). Rankings probabilities indicated that mind-body therapy (79%), interpersonal psychotherapy (71%), cognitive-behavioral therapy (62%), supportive therapy (57%), and education (57%) might be the top five most significantly effective treatments for depression in people living with HIV, in that order. For acceptability, only supportive therapy and interpersonal psychotherapy were significantly less acceptable than most control conditions (odds ratios ranged from 1.92 to 3.43). Rankings probabilities indicated that education might be the most acceptable treatment for people living with HIV (66%), while supportive therapy (26%) and interpersonal psychotherapy (10%) might rank the worst. The GRADE assessment results suggested that most results were rated as "moderate" to "very low" for the confidence of evidence. CONCLUSIONS Our study confirmed the efficacy and acceptability of several non-pharmacological treatments for depression in people living with HIV. These results should inform future guidelines and clinical decisions for depression treatment in people living with HIV.
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12
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Kulisewa K, Minnick CE, Stockton MA, Gaynes BN, Hosseinipour MC, Mphonda S, Sansbury G, Udedi MM, Pence BW. The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective. Glob Public Health 2023; 18:2201327. [PMID: 37088107 PMCID: PMC10465971 DOI: 10.1080/17441692.2023.2201327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depression in sub-Saharan Africa. We conducted in-depth interviews from June to December 2018 with eleven patients enrolled in Project SOAR-Mental Health, a pilot project integrating depression treatment into HIV care in Malawi. Patients treated with amitriptyline or fluoxetine participated in interviews exploring antidepressant acceptability through patient knowledge, side effect severity, pill burden, adherence, perceived efficacy, and tolerability. Patients described a lack of detailed antidepressant education from their providers. Variable, typically self-limiting side effects were reported from both amitriptyline and fluoxetine. While most side effects were mild, three patients reported functional impairment. Patients reported high adherence, though the additional pill burden was a challenge. Most patients found the antidepressants efficacious, tolerable, beneficial and acceptable. Although patient psychoeducation is notably lacking as a facet of clinical management, antidepressant prescription by primary care providers appears acceptable for comorbid severe depression in PLWH initiating HIV care in sub-Saharan Africa. Health workers should be mindful of dosing to minimise side effects and considerate of the additional pill burden.Trial registration: ClinicalTrials.gov ID [NCT03555669]. Retrospectively registered on 13 June 2018.
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Affiliation(s)
- Kazione Kulisewa
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Caroline E. Minnick
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Melissa A. Stockton
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Mina C. Hosseinipour
- Tidziwe Centre, University of North Carolina Project-Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Steven Mphonda
- Tidziwe Centre, University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Griffin Sansbury
- Tidziwe Centre, University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Brian W. Pence
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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13
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Nakimuli-Mpungu E, Smith CM, Wamala K, Okello J, Birungi J, Etukoit M, Mojtabai R, Nachega JB, Harari O, Musisi S, Mills EJ. Long-Term Effect of Group Support Psychotherapy on Depression and HIV Treatment Outcomes: Secondary Analysis of a Cluster Randomized Trial in Uganda. Psychosom Med 2022; 84:914-923. [PMID: 36162067 PMCID: PMC9553261 DOI: 10.1097/psy.0000000000001128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to determine the effect of group support psychotherapy (GSP) compared with group HIV education (GHE) on depression and HIV treatment outcomes 24 months after treatment. We further aimed to investigate the mediating role of depression and antiretroviral therapy (ART) adherence in the relationship between GSP and viral load suppression. METHODS Thirty HIV clinics across three districts were randomly assigned to deliver either GSP or GHE for depression. Depression and optimal (≥95%) ART adherence was assessed at baseline and 6, 12, 18, and 24 months after treatment. Viral load was drawn from the medical charts at baseline and 12 and 24 months after treatment. Multilevel mixed-effects regression models and generalized structural equation modeling were used to estimate 24-month outcomes and mediation effects. RESULTS Participants ( N = 1140) were enrolled from HIV clinics offering either GSP ( n = 578 [51%]) or GHE ( n = 562 [49%]). Fewer GSP than GHE participants met the criteria for depression at 24 months after treatment (1% versus 25%; adjusted odds ratio [aOR] = 0.002, 95% confidence interval [CI] = 0.0002-0.018). More GSP than GHE participants reported optimal (≥95%) ART adherence (96% versus 88%; aOR = 20.88, 95% CI = 5.78-75.33) and improved viral suppression (96% versus 88%; aOR = 3.38, 95% CI = 1.02-11.02). The indirect effects of GSP through sequential reduction in depression and improvement in ART adherence at 12 months may partially explain the higher viral suppression rates at 24 months in GSP than GHE groups. CONCLUSION In settings where the HIV epidemic persists, depression treatment with GSP may be critical for optimal HIV treatment outcomes.Trial Registration: The Pan African Clinical Trials Registry, number PACTR201608001738234.
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14
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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15
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Musisi S, Nakasujja N. Psychiatric Problems in HIV Care. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.106077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Psychiatric problems associated with HIV/AIDS are many, varied and often bidirectional and they are often neglected. Their presence compromises HIV care and prevention efforts. Unaddressed, they compromise treatment outcomes, increase HIV virus–resistant strains, leave pockets of potential HIV spread in the community and lead to poor quality of life and early death of Persons Living With HIV/AIDS. This chapter focuses on specific HIV-associated mental disorders and their management. However, the mental health problems of HIV/AIDS go beyond disorders to include social, family and community problems such as the problems faced by AIDS orphans, widowhood, family disruptions, multiple deaths, bereavements, poverty, stigma, caregiver burden, education and occupational difficulties etc. All these need to be addressed in holistic HIV care. This calls for more research and integration of mental healthcare in all HIV/AIDS treatment and prevention programs.
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Sileo KM, Wanyenze RK, Schmarje Crockett K, Naigino R, Ediau M, Lule H, Kalichman SC, Lin CD, Menzies N, Bateganya MH, Kiene SM. Prevalence and correlates of depressive symptoms, and points of intervention, in rural central Uganda: results from a cross-sectional population-based survey of women and men. BMJ Open 2022; 12:e054936. [PMID: 35641013 PMCID: PMC9157366 DOI: 10.1136/bmjopen-2021-054936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The present study aimed to identify the prevalence and correlates of depressive symptoms and potential intervention points among women and men from a population-based sample in rural central Uganda. DESIGN A cross-sectional study. SETTING Four districts in rural Uganda. PARTICIPANTS Women and men aged 15-59 residing in four districts in rural Uganda accepting home-based HIV testing who completed a baseline survey at the time of testing. PRIMARY OUTCOME MEASURES Depressive symptoms measured by the 10-item Center for Epidemiological Studies Depression Scale using a cut-off score of 13 for significant depressive symptoms. RESULTS Among a sample of 9609 women and 6059 men, 1415 (14.7%) women and 727 (12.0%) men met criteria for significant depressive symptoms. Having ever received mental health services was associated with lower odds of significant depressive symptoms (women: adjusted OR (adjOR)=0.32, 95% CI=0.22 to 0.47; men: adjOR=0.36, 95% CI=0.18 to 0.62). Having received outpatient (women: adjOR=3.64, 95% CI=3.14 to 4.22; men: adjOR=3.37, 95% CI=2.78 to 4.07) or inpatient (women: adjOR=5.44, 95% CI=4.24 to 6.97; men: adjOR=3.42, 95% CI=2.21 to 5.28) care in the prior 6 months was associated with greater odds of significant depressive symptoms. For women only, known HIV positive status (adjOR=1.37, 95% CI=1.05 to 1.77), and for men only, alcohol misuse (adjOR=1.38, 95% CI=1.12 to 1.70), were associated with increased odds of significant depressive symptoms. CONCLUSION Our findings suggest that depression screening within outpatient and inpatient settings may help to identify people in need of mental health services. Routine screening in outpatient or inpatient clinics along with the implementation of evidence-based interventions could ultimately help close the mental health gap for depression in this and similar settings.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Rose Naigino
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Haruna Lule
- Division of Health Systems Strengthening, Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Chii-Dean Lin
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Nicolas Menzies
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Moses H Bateganya
- Infectious Diseases and Health Systems, FHI 360, Durham, North Carolina, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
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17
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Bwanika JM, Hawkins C, Kamulegeya L, Onyutta P, Musinguzi D, Kusasira A, Musoke EK, Kabeega J. Qualitative study of mental health attribution, perceptions and care-seeking in Kampala, Uganda. S Afr J Psychiatr 2022; 28:1690. [PMID: 35747338 PMCID: PMC9210188 DOI: 10.4102/sajpsychiatry.v28i0.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mental health problems contribute to a substantial proportion of the global burden of disease. In Uganda, the World Health Organization estimates that 2.2 million people are affected by mental health disorders. Further research is needed to highlight people’s views about mental health in order to ensure that services are appropriate, accessible and effective. Aim This qualitative study aimed to explore perceptions, experiences and care-seeking preferences to inform stakeholders looking to provide contextually appropriate mental health programmes. Setting A diverse neighbourhood in central Kampala, Uganda. Methods The authors conducted 56 in-depth semi-structured interviews with people over the age of 37 years from November 2018 to May 2019. Results Participants discussed interpersonal and systemic issues that affect mental health in their community and the existing coping mechanisms that people employ. Social factors were often associated with mental health problems, with 36% of participants attributing them to economic stressors in particular. Mental health services were often perceived to be unavailable, costly or stigmatised, which can mean that care-seeking is delayed until problems become severe. Some people said they prefer to turn to prayer (25%) or counselling within their family or community (12.5%). Conclusion Mental health problems are often attributed to socioeconomic factors, which can also hinder access to services. An understanding of perceptions about mental health can help to align programmes for appropriateness and effectiveness. Our study suggests that beneficial additional services for people living in low-income urban settings in Uganda could include those which are free, community-based or offering financial support.
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Affiliation(s)
- John M Bwanika
- Department of Research, The Medical Concierge Group, Kampala, Uganda
- Infectious Diseases Institute Limited, Kampala, Uganda
| | - Charlotte Hawkins
- Department of Anthropology, University College London, London, United Kingdom
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18
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Internalized stigma, depressive symptoms, and the modifying role of antiretroviral therapy: A cohort study in rural Uganda. SSM - MENTAL HEALTH 2021; 1. [PMID: 35252904 PMCID: PMC8896824 DOI: 10.1016/j.ssmmh.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Depression affects over 40% of people with HIV (PHIV) in low- and middle-income countries, and over half of PHIV report HIV-related internalized stigma. However, few longitudinal studies of PHIV have examined the relationship between HIV-related stigma and depression. Data were analyzed from the 2007–15 Uganda AIDS Rural Treatment Outcomes (UARTO) Study, a cohort of 454 antiretroviral therapy (ART)-naïve PHIV (68% women) starting ART. Our primary outcome was depression symptom severity over the first two years of ART, measured using a locally adapted version of the Hopkins Symptom Checklist; our primary exposure was the 6-item Internalized AIDS-Related Stigma Scale. Both scores were measured at enrollment and at quarterly follow-up visits. We fit linear generalized estimating equations (GEE) regression models to estimate the association between stigma and depression symptom severity, adjusting for potential confounders. We included a stigma×time product term to assess the modifying effect of ART on the association between internalized stigma and depression symptom severity. UARTO participants had a median age of 32 years and median enrollment CD4 count of 217 cells/mm3. Both depression symptom severity and internalized stigma declined on ART, particularly during the first treatment year. In multivariable regression models, depression symptom severity was positively associated with internalized stigma (b=0.03; 95% confidence interval [CI], 0.02 to 0.04) and negatively associated with ART duration >6 months (b =− 0.16; 95% CI,− 0.19 to −0.13). The estimated product term coefficient was negative and statistically significant (P = 0.004), suggesting that the association between internalized stigma and depression symptom severity weakened over time on ART. Thus, in this large cohort of PHIV initiating ART in rural Uganda, depression symptom severity was associated with internalized stigma but the association declined with time on ART. These findings underscore the potential value of ART as a stigma reduction intervention for PHIV, particularly during early treatment.
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Alinaitwe R, Birungi C, Bangirana P, Nakasujja N. Prevalence and factors associated with depressive illness in patients with tuberculosis in Mulago hospital, Kampala- Uganda: A cross sectional study. J Psychosom Res 2021; 149:110591. [PMID: 34390942 DOI: 10.1016/j.jpsychores.2021.110591] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depression is a major cause of the global disease burden and globally affects 350-400 million persons making it the largest contributor to years lived with disability. Among of patients with chronic physical illnesses like tuberculosis, depression affects up to 25-33% of individuals. There are limited studies on the comorbidity of depressive illness and tuberculosis in the Ugandan setting. Our aim was to determine the prevalence and factors associated with depressive illness in patients with tuberculosis in Mulago Hospital, Uganda. METHODS This was a cross sectional study involving 308 consecutively sampled participants aged 18 years and above diagnosed with tuberculosis attending the tuberculosis clinic in Mulago Hospital, Uganda. Consecutive sampling was done for a sample size of 308 participants. Participants had the following instruments administered to them; the Socio-demographic questionnaire, the Mini Neuropsychiatric Interview (MINI) to diagnose depressive illness and the Patient Health Questionnaire- 9 to rate the severity of depression. Data was entered using Epi-Data. Descriptive, bivariate and multivariate analyses were done with the Statistical Package for Social Sciences (SPSS). RESULTS the prevalence of depressive illness was 23.7% (95% confidence interval 19.3-28.9). Depressive illness was independently associated with low education level (AOR = 0.39, 95%CI = 0.21-0.72, p = 0.003), being in the intensive phase of TB treatment (AOR = 2.34, 95%CI = (1.27-4.33), p = 0.007) and family history of depressive illness (AOR = 5.42, 95%CI = 2.02-14.54, p = 0.001). On the PHQ, 60.3% had moderate to severe depression. CONCLUSION Depressive illnesses should be screened and managed among patients with TB. RECOMMENDATION Depression should be routinely screened and managed among patients with Tuberculosis.
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Affiliation(s)
- Racheal Alinaitwe
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Caroline Birungi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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21
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Simpson N, Kydd A, Phiri M, Mbewe M, Sigande L, Gachie T, Ngobeni M, Monese T, Figerova Z, Schlesinger H, Bond V, Belemu S, Simwinga M, Schaap A, Biriotti M, Fidler S, Ayles H. Insaka: mobile phone support groups for adolescent pregnant women living with HIV. BMC Pregnancy Childbirth 2021; 21:663. [PMID: 34592959 PMCID: PMC8482634 DOI: 10.1186/s12884-021-04140-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile phone-based interventions have been demonstrated in different settings to overcome barriers to accessing critical psychosocial support. In this study, we aimed to assess the acceptability and feasibility of a phone-based, peer-to-peer support group intervention for adolescent pregnant women aged 15-24 years living with HIV in Zambia. METHODS Sixty-one consenting participants were recruited from Antenatal Clinics of two large urban communities in Lusaka. They were invited to participate in the mobile phone-based intervention that allowed them to anonymously communicate in a small group led by a facilitator for 4 months. A mixed methods approach was used to assess acceptability and feasibility, including a focus group discussion, pre- and post-intervention interview and analysis of the content of the text message data generated. RESULTS Participants reported finding the platform "not hard to use" and enjoyed the anonymity of the groups. Seventy-one percent of participants (n = 43) participated in the groups, meaning they sent text messages to their groups. Approximately 12,000 text messages were sent by participants (an average of 169 messages/user and 6 mentors in 6 groups. Topics discussed were related to social support and relationships, stigma, HIV knowledge and medication adherence. CONCLUSION The study showed that the intervention was acceptable and feasible, and highlighted the potential of the model for overcoming existing barriers to provision of psychosocial support to this population.
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Affiliation(s)
- Nikita Simpson
- Department of Anthropology, London School of Economics and Political Science, London, UK.
- SHM Foundation, 20-22 Bedford Row, London, UK.
| | - Anna Kydd
- SHM Foundation, 20-22 Bedford Row, London, UK
| | | | | | | | | | | | | | | | | | - Virginia Bond
- Zambart, Lusaka, Zambia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Sarah Fidler
- Department of Infectious Diseases, Imperial College, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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22
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Nakku JEM, Nalwadda O, Garman E, Honikman S, Hanlon C, Kigozi F, Lund C. Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study. BMC Pregnancy Childbirth 2021; 21:584. [PMID: 34429087 PMCID: PMC8386083 DOI: 10.1186/s12884-021-04043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. METHODS Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14. RESULTS A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI - 6.79 to - 3.47, p < 0.001) and 7.13 (95%CI - 8.68 to - 5.59, p < 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by - 11.78 points (CI 17.64 to - 5.92, p < 0.001) at midline and - 22.92 points (CI 17.64 to - 5.92, p < 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4-76.6%) and 93.7% (95%CI 87.8-96.8%) of respondents at midline and endline, respectively. CONCLUSION An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.
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Affiliation(s)
| | - Oliva Nalwadda
- Butabika National Referral Mental Hospital, Kampala, Uganda.
| | - Emily Garman
- Department of psychiatry and mental health, University of Cape Town, Cape Town, South Africa
| | - Simone Honikman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.,Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fred Kigozi
- Butabika National Referral Mental Hospital, Kampala, Uganda
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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23
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Mendez NA, Mayo D, Safren SA. Interventions Addressing Depression and HIV-Related Outcomes in People with HIV. Curr HIV/AIDS Rep 2021; 18:377-390. [PMID: 34014446 PMCID: PMC8136266 DOI: 10.1007/s11904-021-00559-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW People with HIV (PWH) are more likely to experience depression than those without HIV. Depression is not only distressing and interfering in and of itself, but it is also consistently associated with non-adherence to antiretroviral treatment (ART). Accordingly, research and clinical priorities require updated knowledge about interventions that address depression in PWH. RECENT FINDINGS Twenty efficacy trials and nine pilot studies since a 2009 review emerged in the literature review search. Of these, 11 and 6 respectively had a depression-related inclusion criterion. The intervention strategies included individual psychotherapy (n=6), group therapy (n=6), telehealth (n=3), and antidepressant medication (n=5). Generally, these interventions demonstrated acute efficacy for improving depression symptoms in PWH, with some also addressing ART non-adherence. However, not all studies collected follow-up data. Furthermore, trials that addressed depression but did not specifically address non-adherence did not also show adherence improvements. Existing interventions for depression have demonstrated efficacy in PWH, and these may have both positive mental and physical health outcomes. Future trials should measure and boost longer-term effects. It would be useful to incorporate adherence interventions into depression treatment to improve self-care behaviors and health outcomes.
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Affiliation(s)
- Noelle A. Mendez
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL USA
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Smith TB, Workman C, Andrews C, Barton B, Cook M, Layton R, Morrey A, Petersen D, Holt-Lunstad J. Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials. PLoS Med 2021; 18:e1003595. [PMID: 34003832 PMCID: PMC8130925 DOI: 10.1371/journal.pmed.1003595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness. METHODS AND FINDINGS We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled. CONCLUSIONS In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation.
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Affiliation(s)
- Timothy B. Smith
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Connor Workman
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Caleb Andrews
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Bonnie Barton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Matthew Cook
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Ryan Layton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Alexandra Morrey
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Devin Petersen
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Julianne Holt-Lunstad
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
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Zhong H, Arjmand IK, Brandeau ML, Bendavid E. Health outcomes and cost-effectiveness of treating depression in people with HIV in Sub-Saharan Africa: a model-based analysis. AIDS Care 2021; 33:441-447. [PMID: 31986900 PMCID: PMC7382984 DOI: 10.1080/09540121.2020.1719966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
Abstract
High prevalence of depression among people living with HIV (PLHIV) impedes antiretroviral therapy (ART) adherence and viral suppression. We estimate the effectiveness and cost-effectiveness of strategies to treat depression among PLHIV in Sub-Saharan Africa (SSA). We developed a microsimulation model of HIV disease and care in Uganda which captured individuals' depression status and the relationship between depression and HIV behaviors. We consider a strategy of screening for depression and providing antidepressant therapy with fluoxetine at ART initiation or re-initiation (if a patient has dropped out). We estimate that over 10 years this strategy would reduce prevalence of depression among PLHIV by 16.0% [95% uncertainty bounds 15.8%, 16.1%] from a baseline prevalence of 28%, increase adherence to ART by 1.0% [1.0%, 1.0%], and decrease rates of loss to followup by 3.7% [3.4%, 4.1%]. This would decrease first-line ART failure rates by 2.5% [2.3%, 2.8%] and increase viral suppression rates by 1.0% [1.0%, 1.0%]. This strategy costs $15/QALY compared to the status quo, and was highly cost-effective over a broad range of sensitivity analyses. We conclude that screening for and treating depression among PLHIV in SSA with fluoxetine would be effective in improving HIV treatment outcomes and would be highly cost-effective.
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Affiliation(s)
- Huaiyang Zhong
- Department of Management Science and Engineering, Stanford
University, Stanford, CA
| | - Isabel K. Arjmand
- Department of Management Science and Engineering, Stanford
University, Stanford, CA
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford
University, Stanford, CA
| | - Eran Bendavid
- Division of General Medical Disciplines, Department of
Medicine, Stanford University, Stanford, CA
- Center for Health Policy and the Center for Primary Care
and Outcomes Research, Stanford University, Stanford, CA
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HATCHER AM, BRITTAIN K, PHILLIPS TK, ZERBE A, ABRAMS EJ, MYER L. Longitudinal association between intimate partner violence and viral suppression during pregnancy and postpartum in South African women. AIDS 2021; 35:791-799. [PMID: 33587440 PMCID: PMC7969405 DOI: 10.1097/qad.0000000000002796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined the longitudinal association between women's exposure to intimate partner violence (IPV) and HIV viral load during pregnancy and postpartum. DESIGN Secondary analysis of an HIV-positive cohort enrolled during pregnancy at a South African antenatal clinic. METHODS Viral load was assessed at 10 study visits and analyzed continuously as log10 copies/ml and suppression at less than 50 copies/ml. IPV was measured at three timepoints using behaviorally specific items. We used multivariate logistic regression to examine the association between IPV and viral suppression, and cross-lagged dynamic panel modeling (DPMs) to estimate the longitudinal association between IPV (lagged by 3-6 months) and log10 viral load. RESULTS Of 471 women, 84% were virally suppressed by 6 weeks postpartum and 67% at 12 months postpartum. One-third reported IPV exposure. IPV victimization was not associated with viral suppression at delivery, but was associated with a reduced odds of viral suppression at 12 months postpartum (aOR = 0.48, 95% CI = 0.27-0.85). Findings were robust to sensitivity analyses at different timepoints and clinical cut-points. In DPMs, lagged IPV exposure was associated with higher log10 viral load after controlling for past viral load, duration on ART, age, alcohol use, and gestation at study enrolment. Each standardized increase in IPV intensity was associated with higher log10 viral load (standardized coefficient = 0.12, 95% CI = 0.05-0.23). CONCLUSION Although viral suppression was widely achieved during pregnancy, suppression rates declined postpartum in this South African cohort. These data suggest IPV is longitudinally associated with elevated viral load postpartum. Interventions for reducing exposure to IPV are important for the health of women and may improve HIV care and treatment.
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Affiliation(s)
- Abigail M HATCHER
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kirsty BRITTAIN
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tamsin K PHILLIPS
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison ZERBE
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Elaine J ABRAMS
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Landon MYER
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Pericot-Valverde I, Heo M, Niu J, Norton BL, Akiyama MJ, Agyemang L, Litwin AH. Declines in Depressive Symptoms Among People who Inject Drugs Treated With Direct-Acting Antivirals While on Opioid Agonist Therapy. Open Forum Infect Dis 2021; 7:ofaa380. [PMID: 33381611 PMCID: PMC7751182 DOI: 10.1093/ofid/ofaa380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Hepatitis C virus (HCV) frequently co-occurs with symptoms of depression, which are aggravated on interferon-based regimens. However, it is unknown whether HCV treatment with direct-acting antivirals (DAAs) has effects on depressive symptoms among people who inject drugs (PWID). In this study, we examined changes in depressive symptoms during and after HCV treatment among PWID on opioid agonist therapies (OATs). Methods Participants were 141 PWID who achieved sustained viral response after on-site HCV treatment at 3 OAT programs. Depressive symptoms were assessed using the Beck Depression Inventory–II (BDI-II) at baseline, every 4 weeks during treatment, and 12 and 24 weeks after treatment completion. Current diagnosis of depression or other psychiatric diagnoses were obtained through chart review. Use of illicit drugs was measured by urine toxicology screening. Alcohol use was measured using the Addiction Severity Index–Lite. Results Of the 141 PWID infected with HCV, 24.1% had severe, 9.9% had moderate, 15.6% had mild, and 50.4% had minimal levels of depression as per BDI-II scores at baseline. HCV treatment was significantly associated with reductions in depressive symptoms that persisted long term, regardless of symptom severity (P < .001) or presence of depression (P ≤ .01) or other psychiatric diagnoses (P ≤ .01) at baseline. Concurrent drug use (P ≤ .001) or hazardous alcohol drinking (P ≤ .001) did not interfere with reductions in depressive symptoms. Conclusions Depressive symptoms are highly prevalent among HCV-infected PWID. HCV treatment was associated with sustained reductions in depressive symptoms. HCV therapy with DAAs may have important implications for PWID that go beyond HCV cure.
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Affiliation(s)
- Irene Pericot-Valverde
- Clemson University School of Health Research, Clemson, South Carolina, USA.,Department of Medicine, Prisma Health, Greenville, South Carolina, USA
| | - Moonseong Heo
- Department of Public Health Science, Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Jiajing Niu
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, USA
| | | | | | | | - Alain H Litwin
- Clemson University School of Health Research, Clemson, South Carolina, USA.,Department of Medicine, Prisma Health, Greenville, South Carolina, USA.,Department of Medicine, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
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Larsen A, Kinuthia J, Lagat H, Sila J, Abuna F, Kohler P, John-Stewart G, Pintye J. Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya. Int J STD AIDS 2020; 31:652-664. [PMID: 32538330 DOI: 10.1177/0956462420920423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed prevalence of human immunodeficiency virus (HIV) risk behaviors and depressive symptoms among adolescent girls and young women (AGYW) aged 15-24 years attending four public family planning clinics in Western Kenya from January to June 2019. Moderate-to-severe depression (MSD) was defined as a Center for Epidemiologic Studies Depression Scale (CESD-10) score ≥10. Among 487 AGYW, the median age was 22 years (interquartile range 20-23), and 59 (12%) AGYW reported MSD. MSD was more prevalent among AGYW without a current partner (p = 0.001) and associated with HIV risk factors including partner ≥10 years older, recent transactional sex, forced sex, intimate partner violence, and alcohol use (each p ≤ 0.005). Thirty-four percent of AGYW with MSD had a high HIV risk score corresponding to 5 to 15 incident HIV cases per 100 person-years. Overlapping high prevalence of depression and HIV risk among AGYW underscores the need for integrated mental health and HIV services in family planning clinics.
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Affiliation(s)
- Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, USA.,Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,University of Washington, Department of Medicine, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
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29
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Zani B, Fairall L, Petersen I, Folb N, Bhana A, Thornicroft G, Hanass-Hancock J, Lund C, Bachmann M. Predictors of receiving a diagnosis, referral and treatment of depression in people on antiretroviral therapy in South African primary care: a secondary analysis of data from a randomised trial. Trop Med Int Health 2020; 25:1450-1466. [PMID: 32985080 PMCID: PMC7756779 DOI: 10.1111/tmi.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care. Methods This is a secondary analysis of data from a randomised controlled trial of an intervention intended to improve detection and treatment of depression in primary care patients receiving ART. In this analysis, we combined cross‐sectional and longitudinal data from the intervention and control arms. Using regression models and adjusting for intra‐cluster correlation of outcomes, we investigated associations between socioeconomic characteristics, depressive symptoms, stress, disability and stigma, and receipt of a diagnosis, referral and treatment for depression. Results Of 2002 participants enrolled, 18% reported a previous diagnosis of depression by a healthcare worker and 10% reported having received counselling from a specialist mental health worker. Diagnosis, referral and counselling during the follow‐up period were appropriately targeted, being independently more frequent in participants with higher enrolment scores for depressive symptoms, stress or disability. Participants with higher stigma scores at enrolment were independently less likely to receive counselling. Severe socio‐economic deprivation was common but was not associated with treatment. Conclusion While the receipt of a diagnosis, referral and treatment for depression were uncommon, they seemed to be appropriately targeted. Socio‐economic deprivation was not associated with treatment.
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Affiliation(s)
- B Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - L Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,King's Global Health Institute, King's College London, London, UK.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - I Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - N Folb
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - A Bhana
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.,Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - G Thornicroft
- Centre for Global Mental Health, King's College London, London, UK
| | - J Hanass-Hancock
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.,School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C Lund
- Centre for Global Mental Health, King's College London, London, UK.,Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
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30
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Ezeanolue EE, Iheanacho T, Adedeji IA, Itanyi IU, Olakunde B, Patel D, Dakum P, Okonkwo P, Akinmurele T, Obiefune M, Khamofu H, Oyeledun B, Aina M, Eyo A, Oleribe O, Oko J, Olutola A, Gobir I, Aliyu MH, Aliyu G, Woelk G, Aarons G, Siberry G, Sturke R. Opportunities and challenges to integrating mental health into HIV programs in a low- and middle-income country: insights from the Nigeria implementation science Alliance. BMC Health Serv Res 2020; 20:904. [PMID: 32993621 PMCID: PMC7526407 DOI: 10.1186/s12913-020-05750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria. Method Attendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis. Results The two major theoretical themes from the study were – opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps). Conclusions Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians’ training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.
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Affiliation(s)
- Echezona E Ezeanolue
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, Yale University, 300 George Street, New Haven, CT, 06511, USA.
| | | | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Babayemi Olakunde
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,National Agency for Control of AIDS, Abuja, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA.,Institute of Human Virology, Abuja, Nigeria
| | | | | | | | | | | | | | - Andy Eyo
- Excellence Community Education Welfare Scheme, Abuja, Nigeria
| | - Obinna Oleribe
- Excellence and Friends Management Consult, Abuja, Nigeria
| | - John Oko
- Catholic Caritas Foundation Nigeria, Abuja, Nigeria
| | | | - Ibrahim Gobir
- Center for Global Health Practice and Impact, Georgetown University, Washington, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gambo Aliyu
- National Agency for Control of AIDS, Abuja, Nigeria
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, USA
| | | | - George Siberry
- United States Agency for International Development, Washington, USA
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, N’guessan Abouo F, Tanon A, Messou E, Seydi M, Dabis F, de Rekeneire N. Prevalence and factors associated with severe depressive symptoms in older west African people living with HIV. BMC Psychiatry 2020; 20:442. [PMID: 32912173 PMCID: PMC7481548 DOI: 10.1186/s12888-020-02837-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depression is one of the most common psychiatric disorders in people living with HIV (PLHIV). Depression has a negative impact on both mental and physical health and is mainly associated with suboptimal HIV treatment outcomes. To encourage successful aging and the achievement of the 3 × 90 objectives in older PLHIV, the psychological domain must not be neglected. In this context and as data are scarce in West Africa, this study aimed to evaluate the prevalence and the factors associated with severe depressive symptoms in older PLHIV living in this region of the world. METHODS Data from PLHIV aged ≥50 years and on ART since ≥6 months were collected in three clinics (two in Côte d'Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. The severity of depressive symptoms was measured using the Center for Epidemiological Studies Depression scale (CES-D), and associated factors were identified using logistic regressions. RESULTS The median age of the 334 PLHIV included in the study was 56.7 (53.5-61.1), 57.8% were female, and 87.1% had an undetectable viral load. The prevalence of severe depressive symptoms was 17.9% [95% Confidence Interval (95% CI): 13.8-22.0]. PLHIV with severe depressive symptoms were more likely to be unemployed (adjusted Odd Ratio (aOR) = 2.8; 95% CI: 1.4-5.7), and to be current or former tobacco smokers (aOR = 2.6; 95% CI: 1.3-5.4) but were less likely to be overweight or obese (aOR = 0.4; 95% CI: 0.2-0.8). CONCLUSIONS The prevalence of severe depressive symptoms is high among older PLHIV living in West Africa. Unemployed PLHIV and tobacco smokers should be seen as vulnerable and in need of additional support. Further studies are needed to describe in more details the reality of the aging experience for PLHIV living in SSA. The integration of screening and management of depression in the standard of care of PLHIV is crucial.
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Affiliation(s)
- Charlotte Bernard
- Bordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000, Bordeaux, France. .,Bordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000, Bordeaux, France.
| | - Hélène Font
- grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000 Bordeaux, France
| | - Zélica Diallo
- grid.411387.80000 0004 7664 5497Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Richard Ahonon
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d’Ivoire
| | - Judicaël Malick Tine
- Service de maladies infectieuses et tropicales, CRCF, CHNU de Fann, Dakar, Senegal
| | - Franklin N’guessan Abouo
- grid.411387.80000 0004 7664 5497Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Aristophane Tanon
- grid.411387.80000 0004 7664 5497Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Eugène Messou
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d’Ivoire
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CRCF, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000 Bordeaux, France
| | - Nathalie de Rekeneire
- grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000 Bordeaux, France
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Asrat B, Lund C, Ambaw F, Schneider M. Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study. PLoS One 2020; 15:e0238321. [PMID: 32853261 PMCID: PMC7451549 DOI: 10.1371/journal.pone.0238321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Psychological treatments improve depressive symptoms in people living with HIV/AIDS (PLWHA). Adaptation of treatments should be based on explanatory models of depression and other elements within the given context. AIM This study aimed to examine explanatory models of depression and acceptable approaches for implementation of group IPT in Northwest Ethiopia. METHODS Qualitative data were collected from April to May 2019 from case managers, adherence supporters and service users using focus group discussion and analysed thematically. RESULTS PLWHA attributed depression to psychosocial problems, spiritual factors and biological factors. Depression had several impacts at individual and family level. Group-based interpersonal therapy (IPT) was acceptable if provided by trained peer counselors. CONCLUSION The current study findings informed how to conduct feasibility and acceptability trials of group IPT in the HIV population in Ethiopia.
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Affiliation(s)
- Biksegn Asrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, King’s Global Health Institute, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Vavani B, Kraaij V, Spinhoven P, Amone-P'Olak K, Garnefski N. Intervention targets for people living with HIV and depressive symptoms in Botswana. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:80-88. [PMID: 32200725 DOI: 10.2989/16085906.2020.1727933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: The prevalence of HIV in Botswana is high. Many people living with HIV (PLWH) suffer from depressive symptoms and have inadequate coping skills. Most PLWH do not receive adequate psychological treatment. Empirically based interventions for PLWH with depressive symptoms in Botswana should be developed, with a focus on improving coping skills. The present study was a first step towards this goal, by trying to identify targets for intervention. The study aimed to provide prevalence rates of depression among PLWH in Botswana, to assess their mental health treatment needs and wishes as expressed by themselves, and to study the relationships between cognitive and behavioural coping strategies and depressive symptoms.Method: A cross-sectional study was conducted. The sample consisted of 291 participants (73% female) from 8 HIV treatment centres from Botswana. Participants completed standardized questionnaires on depressive symptoms (CES-D) and coping skills (CERQ, BERQ). They also answered questions regarding their mental health care needs and wishes.Results: In total 43.4% of participants reported clinically significant depressive symptoms. The majority of participants indicated that they needed help with the following topics: feelings of depression, physical tension, finding new goals and coping with HIV. In addition, they indicated preferring a self-help programme in booklet format. Multiple regression analyses showed that the following coping strategies had significant relationships with depressive symptoms: rumination, catastrophising, withdrawal, positive refocusing and refocus on planning (the latter two negatively).Conclusion: Almost half of the PLWH reported depressive symptoms that were clinically significant. The findings suggested that an intervention for PLWH with depressive symptoms in Botswana should preferably be a self-help programme presented in booklet format. With regard to content, the results confirmed that the intervention should focus on specific coping skills. In addition, elements like goal finding and strategies to reduce physical tension should be added.
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Affiliation(s)
- Boitumelo Vavani
- Psychology Department, University of Botswana, Gaborone, Botswana.,Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Clinical Psychology, Leiden University, Leiden, Netherlands
| | | | - Kennedy Amone-P'Olak
- Department of Psychology, University of Witwatersrand, Johannesburg, South Africa
| | - Nadia Garnefski
- Psychology Department, University of Botswana, Gaborone, Botswana
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Effectiveness of psychological treatments for depressive symptoms among people living with HIV/AIDS in low- and middle-income countries: A systematic review and meta-analysis. J Affect Disord 2020; 270:174-187. [PMID: 32339109 DOI: 10.1016/j.jad.2020.03.068] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/17/2020] [Accepted: 03/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Psychological treatments play a significant role in managing depressive symptoms. However, little is known about the most effective psychological treatments for depressive symptoms for people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). AIMS To identify effective psychological treatments to manage depressive symptoms for adult PLWHA in LMICs and to estimate pooled effect sizes using a meta-analysis. METHOD Four databases were searched using key words and MeSH terms - PubMed, Scopus, Cochrane library and PsychINFO. The inclusion criteria were randomized controlled trials (RCTs) that examine psychological treatments that target depressive symptoms for adult PLWHA in LMICs. The Cochrane risk of bias tool was used to assess the risk of bias. A meta-analysis was done using RevMan-5. RESULT Nineteen studies were included in the systematic review and 14 of them were selected for meta-analysis. Eight (42%) of the trials used cognitive behavioural therapy (CBT). Pooled effect size of trials that used continuous outcomes was -0.61 (n = 12, 95%CI: -1.24, 0.02, I2 = 95%) at post-treatment assessment. The pooled effect size changed to -1.41 (n = 8, 95%CI: -2.54, -0.28, I2 = 98%) at six months post treatment. LIMITATIONS Studies varied in quality from low to high risk of bias and there was high heterogeneity across studies. CONCLUSION Trials used group support psychotherapy, interpersonal therapy, problem-solving therapy, and peer-support counselling were effective in reducing depressive symptoms. However, better powered studies with more consistent methodologies are needed to investigate whether specific therapies delivered by lay counsellors are effective for PLWHA in LMICs.
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Abas MA, Weiss HA, Simms V, Verhey R, Rusakaniko S, Araya R, Chibanda D. The effect of co-morbid anxiety on remission from depression for people participating in a randomised controlled trial of the Friendship Bench intervention in Zimbabwe. EClinicalMedicine 2020; 23:100333. [PMID: 32637890 PMCID: PMC7329733 DOI: 10.1016/j.eclinm.2020.100333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a lack of data from low- and middle-income countries on whether anxiety independently predicts a more chronic course for depression. METHODS We undertook secondary data analysis of a cluster randomised controlled trial in Zimbabwe which had tested the effectiveness of the Friendship Bench intervention for common mental disorders compared to enhanced usual care. Inclusion for the current study was participants from the trial who had probable major depression at baseline, defined as scoring => 11 on the locally validated Patient Health Questionnaire (PHQ9). This emerged to be 354 of the original 573 (61.78%) of the original trial sample. Anxiety was measured using the locally validated cut-point on the Generalised Anxiety Disorder scale (GAD-7). Persistent depression was defined as scoring => 11 on the PHQ-9 at six-months follow-up. Analysis in Stata 15 used random-effects logistic regression to adjust for clustering by clinic. OUTCOMES Of the 354 participants who were eligible for treatment, 329 (92·9%) completed 6-month follow-up assessment. 37% of the trial sample had persistent depression at 6-months follow-up; 59% in the control arm and 17% in the intervention arm. Co-morbid anxiety present at trial baseline was independently associated with persistent depression after adjusting for age, gender and baseline depression severity (adjusted OR = 2·83, 95% CI 1·32-6·07). There was no evidence of effect modification by trial arm. Baseline depression severity also predicted persistent depression. Interpretation Treatment for depression in low and middle-income countries (LMIC) should be directed towards those with greatest need. This includes people with co-morbid anxiety and greater depression severity at initial assessment who are less likely to remit at six months. Advice on coping with anxiety, psychological treatments which target common anxiety symptoms such as fear, avoidance, excessive worry and intrusive thoughts, and Selective Serotonin Reuptake Inhibitors (SSRIs) should be made more widely available in LMIC and offered to those with persistent mixed depression and anxiety.
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Affiliation(s)
- Melanie Amna Abas
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
- Corresponding author at: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Simms
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Verhey
- Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare, Zimbabwe
| | - Ricardo Araya
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Dixon Chibanda
- Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
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Chibanda D, Abas M, Musesengwa R, Merritt C, Sorsdahl K, Mangezi W, Bandawe C, Cowan F, Araya R, Gomo E, Gibson L, Weiss H, Hanlon C, Lund C. Mental health research capacity building in sub-Saharan Africa: the African Mental Health Research Initiative. Glob Ment Health (Camb) 2020; 7:e8. [PMID: 32346483 PMCID: PMC7176917 DOI: 10.1017/gmh.2019.32] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022] Open
Abstract
Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through a theory of change workshop, successes and challenges that have been faced by the consortium in the last 4 years, and the future role that AMARI could play in further building MNS research capacity by brining on board more institutions from low- and middle-income countries with an emphasis on developing an evidence-based training curriculum and a research-driven care service.
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Affiliation(s)
- Dixon Chibanda
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosemary Musesengwa
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Chris Merritt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Walter Mangezi
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Frances Cowan
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Exnevia Gomo
- Department of Immunology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lorna Gibson
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- Department of Mental Health, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
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Nakimuli-Mpungu E, Musisi S, Wamala K, Okello J, Ndyanabangi S, Birungi J, Nanfuka M, Etukoit M, Mayora C, Ssengooba F, Mojtabai R, Nachega JB, Harari O, Mills EJ. Effectiveness and cost-effectiveness of group support psychotherapy delivered by trained lay health workers for depression treatment among people with HIV in Uganda: a cluster-randomised trial. LANCET GLOBAL HEALTH 2020; 8:e387-e398. [PMID: 32035035 DOI: 10.1016/s2214-109x(19)30548-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND WHO recommends the use of psychological interventions as first-line treatment for depression in low-income and middle-income countries. However, evaluations of the effectiveness and cost-effectiveness of such interventions among people with HIV are scarce. Our aim was to establish the effectiveness of group support psychotherapy (GSP) delivered by lay health workers for depression treatment among people living with HIV in a rural area of Uganda on a large scale. METHODS In this cluster-randomised trial, we included 30 health centres offering HIV care. These were randomly assigned to deliver either GSP or group HIV education (GHE). Randomisation, in a ratio of 1:1, was achieved by health centre managers separately picking a paper containing the intervention allocation from a basket. Participants were people living with HIV, aged 19 years and older, with mild to moderate major depression assessed with the Mini International Neuropsychiatric Interview depression module, taking antiretroviral therapy, and antidepressant-naive. Group sessions were led by trained lay health workers once a week for 8 weeks. The primary outcomes were the proportion of participants with major depression and function scores at 6 months post-treatment, analysed by intention to treat by means of multilevel random effect regression analyses adjusting for clustering in health centres. This trial is registered with the Pan African Clinical Trials Registry, PACTR201608001738234. FINDINGS Between Sept 13 and Dec 15, 2016, we assessed 1473 individuals, of whom 1140 were recruited from health centres offering GSP (n=578 [51%]) or GHE (n=562 [49%]). Two (<1%) participants in the GSP group were diagnosed with major depression 6 months post-treatment compared with 160 (28%) in the GHE group (adjusted odds ratio=0·01, 95% CI 0·003-0·012, p<0·0001). The mean function scores 6 months post-treatment were 9·85 (SD 0·76) in the GSP group and 6·83 (2·85) in the GHE group (β=4·12; 95% CI 3·75-4·49, p<0·0001). 36 individuals had 63 serious adverse events, which included 25 suicide attempts and 22 hospital admissions for medical complications. The outcomes of these serious adverse events included 16 deaths, 4 of which were completed suicides (GSP=2; GHE=2), and 12 of which were HIV-related medical complications (GSP=8; GHE=4). Cost-effectiveness estimates showed an incremental cost-effectiveness ratio of US$13·0 per disability-adjusted life-year averted, which can be considered very cost-effective in Uganda. INTERPRETATION Integration of cost-effective psychological treatments such as group support psychotherapy into existing HIV interventions might improve the mental health of people living with HIV. FUNDING MQ Transforming Mental Health and Grand Challenges Canada.
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Affiliation(s)
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kizito Wamala
- Department of Psychology, Center for Victims of Torture, Gulu, Uganda
| | - James Okello
- Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | | | | | | | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jean B Nachega
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Center for Infectious Disease, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | | | - Edward J Mills
- MTEK Sciences, Vancouver, BC, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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Hatcher A, Lemus Hofstedler L, Doria K, Dworkin S, Weke E, Conroy A, Bukusi E, Cohen C, Weiser S. Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings. Transcult Psychiatry 2020; 57:124-139. [PMID: 31242065 PMCID: PMC6930985 DOI: 10.1177/1363461519858446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
While food insecurity and poverty worsen mental health outcomes among people living with HIV/AIDS (PLHIV), few intervention studies have targeted poverty and food insecurity as a way to improve mental health. Among HIV-positive patients, addressing such upstream determinants may prove crucial to ensure better mental health and HIV clinical outcomes. We integrated longitudinal, qualitative research into a randomized trial of a livelihood intervention to understand processes and mechanisms for how the intervention may affect mental health among HIV-infected Kenyan adults. In-depth interviews were conducted with intervention participants (n = 45) and control participants (n = 9) at two time-points (after intervention start and upon intervention end). Interviews (n = 85) were translated, double-coded, and analyzed thematically using an inductive-deductive team approach. Participants reported numerous mental health improvements post-intervention including reduced stress, fewer symptoms of anxiety, improved mood, lower depressive symptoms, fewer repetitive and ruminating thoughts, and more hopefulness for the future. Improvements in mental health appear to occur via several mechanisms including: 1) better food security and income; 2) increased physical activity and ability to create fruitful routines around farm work; and, 3) improved sense of self as an active member of the community. Qualitative, longitudinal interviews may help identify intervention mechanisms for improved mental health, but additional research is required to confirm self-reports of mental health changes. These findings suggest that livelihood interventions may improve mental health in multi-faceted ways, and help PLHIV better integrate with their communities. Trial registered at ClinicalTrials.gov: NCT01548599.
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Affiliation(s)
- A.M Hatcher
- University of the Witwatersrand and an Honorary Researcher at the University of California, San Francisco
| | | | | | - S. Dworkin
- University of Washington Bothell School of Nursing and Health Studies
| | - E. Weke
- Kenya Medical Research Institute (KEMRI)
| | - A. Conroy
- Center for AIDS Prevention Studies at the University of California San Francisco
| | - E. Bukusi
- Kenya Medical Research Institute (KEMRI), University of Washington and University of California San Francisco
| | - C.R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California San Francisco (UCSF) and University of California Global Health Institute (UCGHI)
| | - S.D. Weiser
- Division of HIV, Infectious Disease and Global Medicine at UCSF
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Musisi S, Kinyanda E. Long-Term Impact of War, Civil War, and Persecution in Civilian Populations-Conflict and Post-Traumatic Stress in African Communities. Front Psychiatry 2020; 11:20. [PMID: 32158407 PMCID: PMC7051938 DOI: 10.3389/fpsyt.2020.00020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
This chapter describes how chronic conflict, warfare, and persecution, as lived experiences, have created significant mental distress in communities on the African continent. There is a growing body of research that highlights increasing mental distress in Africa e.g., about sexuality, health, disease, modernity, climate, politics, culture, religion, ethnicities, race, economies etc. Many of these stresses and uncertainties are driven by political persecution, war, and conflict. This has shaped many African people's attitudes and government policies and an increasing scholarly interest in exploring these "uncertainties and mental distresses in Africa." The chapter will show how trauma, as seen in conflict/post-conflict settings in Africa, causes significant mental stress and associated social problems as well as medically-defined PTSD syndromes, anxiety, and depression which cause much morbidity and retard development in many African communities. Taking a classical look at post-traumatic stress disorder, PTSD, the chapter explores the presentation of the various physical and mental clinical syndromes related to war-trauma on the African continent and the consequent health-seeking behaviors of the African peoples in this regard. The term "culture-bound PTSD syndromes" will be introduced and discussed in the broader context of treatment, rehabilitation, and prevention on the continent and worldwide. It will also discuss the dilemma of the vicious cycles of trauma driven by appetitive aggression in today's Africa which portends to further retard socio-economic development and drives the trans-generational perpetuation of ethnic-based conflicts including genocides. Despite this mass traumatization, the chapter points to the virtual absence of post-conflict mental health policies in almost all African countries, hence leading to discussions of "best-practices" recommendations.
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Affiliation(s)
- Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eugene Kinyanda
- College of Health Sciences, Makerere University, Kampala, Uganda
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Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda. J Acquir Immune Defic Syndr 2019; 78:257-268. [PMID: 29509587 PMCID: PMC6012052 DOI: 10.1097/qai.0000000000001671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence. Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda. Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender. Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, <0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing ≥12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner ≥10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40). Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health initiatives are urgently required.
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The Role of Depression Screening and Treatment in Achieving the UNAIDS 90-90-90 Goals in Sub-Saharan Africa. AIDS Behav 2019; 23:153-161. [PMID: 31317365 PMCID: PMC6773678 DOI: 10.1007/s10461-019-02593-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90–90–90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90–90–90 lens through a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as task-shifting strategies for depression management. Due to the lack of mental health infrastructure and human resources, task-shifting approaches that integrate mental health management into existing primary and community health programs are increasingly being piloted and adopted across the region. Greater integration of such mental health care task-shifting into HIV programs will be critical to realizing the 90–90–90 goals and ending the HIV epidemic.
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Hanass-Hancock J, Carpenter B, Myezwa H. The missing link: exploring the intersection of gender, capabilities, and depressive symptoms in the context of chronic HIV. Women Health 2019; 59:1212-1226. [PMID: 31043146 DOI: 10.1080/03630242.2019.1607799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Depressive symptoms occur frequently among people living with HIV, especially women. These symptoms are associated with human, social, financial, and physical/natural capabilities and life stressors that differ between women and men. However, the link between depressive symptoms and functional limitations/disability is seldom discussed in the context of HIV, especially for gender-specific relationships. A cross-sectional survey of 1042 people living with HIV and using long-term antiretroviral therapy (ART) in South Africa was conducted from June to August 2014 to investigate the associations of disability, human, social, physical/natural, and financial capabilities, health, and adherence to ART, including possible gender-specific factors. Socio-demographic information, capabilities, health indicators, functional limitations/disability, and depressive symptoms (CES-D 10) were measured. We applied descriptive and bivariate statistics and multiple regression. Overall, 26% of people presented with depressive symptoms. Greater functional limitations and health symptoms and lower food security were strongly associated with depressive symptoms, while associations with financial capital and body mass index were gender-specific. The results call for the improvement of comprehensive care, including gender-sensitive mental health interventions. The results further indicate that functional limitations/disability needs to be considered, along with linking rehabilitation and livelihood programs with comprehensive HIV-care, in particular for those who experience depressive symptoms.
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Affiliation(s)
- Jill Hanass-Hancock
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bradley Carpenter
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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Nakimuli-Mpungu E, Musisi S, Wamala K, Okello J, Ndyanabangi S, Birungi J, Nanfuka M, Etukoit M, Mojtabai R, Nachega J, Harari O, Mills E. Recruitment and Baseline Characteristics of Participants in the Social, Emotional, and Economic Empowerment Through Knowledge of Group Support Psychotherapy Study (SEEK-GSP): Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11560. [PMID: 30609989 PMCID: PMC6682267 DOI: 10.2196/11560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Psychosocial characteristics, including self-esteem, perceived social support, coping skills, stigma, discrimination, and poverty, are strongly correlated with depression symptoms. However, data on the extent of these correlations among persons living with HIV and the associations between psychosocial characteristics and HIV treatment outcomes are limited in sub-Saharan Africa. OBJECTIVE This paper aims to describe the recruitment process and baseline characteristics associated with depression in a sample of HIV-positive people in a cluster randomized trial of group support psychotherapy (GSP) for depression delivered by trained lay health workers (LHWs). METHODS Thirty eligible primary care health centers across three districts in Uganda were randomly allocated to have their LHWs trained to deliver GSP (intervention arm) or group HIV education and treatment as usual (control arm) to persons living with HIV comorbid with depression. Baseline demographic, socioeconomic, and psychosocial characteristics were collected via interviewer-administered questionnaires. Among eligible participants, differences between those enrolled versus those who refused enrollment were assessed using chi square for categorical variables and t tests for continuous variables. Spearman rank order correlation analyses were conducted to determine associations between baseline depression symptoms and adherence to antiretroviral therapy (ART), viral load suppression, and other psychosocial variables. RESULTS The study screened 1473 people and 1140 were found to be eligible and enrolled over 14 weeks. Participants recruited comprised 95% of the target sample size of 1200. The sample's mean age was 38.5 (SD 10.9) years and both genders were well represented (males: 46.32%, 528/1140). Most participants met the diagnostic criteria for major depressive disorder (96.92%, 1105/1140), had significant posttraumatic stress symptoms (72.46%, 826/1140), reported moderate suicide risk (52.54%, 599/1140), had primary or no formal education (86.22%, 983/1140), and reported no income-generating activity (72.63%, 828/1140) and no food insecurity (81.67%, 931/1140). Among eligible participants, 48 of 1140 (4.21%) refused to participate in the interventions; these participants were more likely to be males (χ21=4.0, P=.045) and have significantly lower depression symptoms scores (t2=2.36, P=.01) than those who participated in the interventions. There was a significant positive correlation between viral load and number of traumatic experiences (ρ=.12, P=.05). Adherence to ART was positively correlated with perceived social support (ρ=.15, P<.001), but negatively correlated with depression symptoms (ρ=-.11, P=.05) and stigma (ρ=-.14, P<.001). CONCLUSIONS Men and women with HIV and depression experience multiple social and economic vulnerabilities and disadvantages. Culturally tailored psychological interventions aimed at these individuals should address these socioeconomic disadvantages in addition to addressing their mental health care needs. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201608001738234; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1738 (Archived by WebCite at http://www.webcitation.org/74NtMphom).
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Affiliation(s)
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kizito Wamala
- Center for Victims of Torture, Department of Psychology, Gulu, Uganda
| | - James Okello
- Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | | | | | | | - Ramin Mojtabai
- Department of Mental Health, Bloomberg's School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jean Nachega
- Department of Epidemiology, Pittsburg Graduate School of Public Health, University of Pittsburg, Pittsburgh, PA, United States.,Stellenbosch Center for Infectious Disease, Department of Medicine, Stellenbosch University, Cape Town, South Africa.,Department of Epidemiology, Bloomberg's School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of International Health, Bloomberg's School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Edward Mills
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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Mutamba BB, Kane JC, de Jong J, Okello J, Musisi S, Kohrt BA. Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda. Psychol Med 2018; 48:2573-2583. [PMID: 29444721 PMCID: PMC6093795 DOI: 10.1017/s0033291718000193] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma. METHODS A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention. RESULTS Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10-0.62] and 6 months (RR 0.33, 95% CI 0.11-0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers. CONCLUSION IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.
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Affiliation(s)
- Byamah B. Mutamba
- Butabika National Mental Hospital, Kampala, Uganda., Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam
| | - Jeremy C. Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Joop de Jong
- Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam
| | - James Okello
- Department of Psychiatry, Gulu University, Uganda
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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Parcesepe AM, Bernard C, Agler R, Ross J, Yotebieng M, Bass J, Kwobah E, Adedimeji A, Goulet J, Althoff KN. Mental health and HIV: research priorities related to the implementation and scale up of ‘treat all’ in sub-Saharan Africa. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30341-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Day S, Blumberg M, Vu T, Zhao Y, Rennie S, Tucker JD. Stakeholder engagement to inform HIV clinical trials: a systematic review of the evidence. J Int AIDS Soc 2018; 21 Suppl 7:e25174. [PMID: 30334358 PMCID: PMC6192899 DOI: 10.1002/jia2.25174] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/20/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Stakeholder engagement is an essential component of HIV clinical trials. We define stakeholder engagement as an input by individuals or groups with an interest in HIV clinical trials to inform the design or conduct of said trials. Despite its value, stakeholder engagement to inform HIV clinical trials has not been rigorously examined. The purpose of our systematic review is to examine stakeholder engagement for HIV clinical trials and compare it to the recommendations of the UNAIDS/AVAC Good Participatory Practice (GPP) guidelines. METHODS We used the PRISMA checklist and identified English language studies describing stakeholder engagement to inform HIV clinical trials. Four databases (PubMed, Ovid, CINAHL and Web of Science) and six journals were searched, with additional studies identified using handsearching and expert input. Two independent reviewers examined citations, abstracts and full texts. Data were extracted on country, engagement methods, stakeholder types and purpose of stakeholder engagement. Based on the GPP guidelines, we examined how frequently stakeholder engagement was conducted to inform clinical trial research question development, protocol development, recruitment, enrolment, follow-up, results and dissemination. RESULTS AND DISCUSSION Of the 917 citations identified, 108 studies were included in the analysis. Forty-eight studies (44.4%) described stakeholder engagement in high-income countries, thirty (27.8%) in middle-income countries and nine (8.3%) in low-income countries. Fourteen methods for stakeholder engagement were identified, including individual (e.g. interviews) and group (e.g. community advisory boards) strategies. Thirty-five types of stakeholders were engaged, with approximately half of the studies (60; 55.6%) engaging HIV-affected community stakeholders (e.g. people living with HIV, at-risk or related populations of interest). We observed greater frequency of stakeholder engagement to inform protocol development (49 studies; 45.4%) and trial recruitment (47 studies; 43.5%). Fewer studies described stakeholder engagement to inform post-trial processes related to trial results (3; 2.8%) and dissemination (11; 10.2%). CONCLUSIONS Our findings identify important directions for future stakeholder engagement research and suggestions for policy. Most notably, we found that stakeholder engagement was more frequently conducted to inform early stages of HIV clinical trials compared to later stages. In order to meet recommendations established in the GPP guidelines, greater stakeholder engagement across all clinical trial stages is needed.
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Affiliation(s)
- Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Meredith Blumberg
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Thi Vu
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Yang Zhao
- University of North Carolina – Project ChinaGuangzhouChina
| | - Stuart Rennie
- Department of Social MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Center for BioethicsUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina – Project ChinaGuangzhouChina
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Faculty of Infectious DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS 2018; 32 Suppl 1:S5-S20. [PMID: 29952786 DOI: 10.1097/qad.0000000000001888] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. DESIGN Systematic review and meta-analysis. METHODS We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. RESULTS Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hypertension 21.2% (95% CI 16.3-27.1), hypercholesterolemia 22.2% (95% CI 14.7-32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2-33.6), hypertriglyceridemia 27.2% (95% CI 20.7-34.8), low high-density lipoprotein 52.3% (95% CI 35.6-62.8), obesity 7.8% (95% CI 4.3-13.9), and depression 24.4% (95% CI 12.5-42.1). Invasive cervical cancer and diabetes prevalence were 1.3-1.7 and 1.3-18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. CONCLUSION Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.
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Adaptation of CBT for Traumatized South African Indigenous Groups: Examples from Multiplex CBT for PTSD. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cuijpers P, Karyotaki E, Reijnders M, Purgato M, Barbui C. Psychotherapies for depression in low- and middle-income countries: a meta-analysis. World Psychiatry 2018; 17:90-101. [PMID: 29352530 PMCID: PMC5775122 DOI: 10.1002/wps.20493] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Most psychotherapies for depression have been developed in high-income Western countries of North America, Europe and Australia. A growing number of randomized trials have examined the effects of these treatments in non-Western countries. We conducted a meta-analysis of these studies to examine whether these psychotherapies are effective and to compare their effects between studies from Western and non-Western countries. We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non-Western countries. The effects of psychotherapies in non-Western countries were large (g=1.10; 95% CI: 0.91-1.30), with high heterogeneity (I2 =90; 95% CI: 87-92). After adjustment for publication bias, the effect size dropped to g=0.73 (95% CI: 0.51-0.96). Subgroup analyses did not indicate that adaptation to the local situation was associated with the effect size. Comparisons with the studies in Western countries showed that the effects of the therapies were significantly larger in non-Western countries, also after adjusting for characteristics of the participants, the treatments and the studies. These larger effect sizes in non-Western countries may reflect true differences indicating that therapies are indeed more effective; or may be explained by the care-as-usual control conditions in non-Western countries, often indicating that no care was available; or may be the result of the relative low quality of many trials in the field. This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non-Western countries, but they are probably no less effective and can therefore also be used in these latter countries.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands,Amsterdam School of Public HealthAmsterdamThe Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands,Amsterdam School of Public HealthAmsterdamThe Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands,Amsterdam School of Public HealthAmsterdamThe Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVeronaItaly
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVeronaItaly
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Lofgren SM, Nakasujja N, Boulware DR. Systematic Review of Interventions for Depression for People Living with HIV in Africa. AIDS Behav 2018; 22:1-8. [PMID: 28900756 DOI: 10.1007/s10461-017-1906-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Depression interventions for individuals with HIV/AIDS in Africa are being increasingly evaluated. MEDLINE was searched using key terms: depression, Africa, and HIV, to identify depression interventions for HIV-infected adults in Africa. Perinatal women were excluded. Results were extracted and relative change in depression scores for interventions and net effect calculated. The MEDLINE search yielded 18 articles. Six of seven studies evaluating feasibility were positive, and seven of seven studies evaluating acceptability were also positive. Three studies investigated the effect of psychotherapy (% relative decrease of depressive symptoms for intervention: %net decrease compared to controls) (73%:39% decrease). Four studies investigated task-shifting of psychotherapy (47%:34% decrease). Three studies evaluated antidepressants (79%:39% decrease). Three studies investigated task-shifting of antidepressant treatment (82%:65% decrease). An exercise intervention was evaluated (66%:49% decrease). One trial investigated minocycline with non-statistically significant results. Finally, three studies investigated other psychosocial interventions (44%:21% decrease). Overall, the results highlight the need for large, randomized trials to establish efficacy as well as implementation studies.
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