Novel approach to scale integrated depression and HIV care

Development and Pilot-Testing of an Optimized Conversational Agent or "Chatbot" for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study

BACKGROUND

Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings.

OBJECTIVE

The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV.

METHODS

Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage.

RESULTS

The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter.

CONCLUSIONS

The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55559.

Association of indoor noise level with depression in hotel workers: A multicenter study from 111 China's cities

Several studies have elucidated the link between outdoor noise and depression, but the relationship between indoor noise levels and depression symptoms in residential and public places remains unclear. This study was a multicenter observational study with a cross-sectional design. In 2019, a total of 10 545 indoor noise levels on-site and 26 018 health data from practitioners were collected from 2402 hotels in 111 cities. Indoor daily noise data levels were detected, and PHQ-9 questionnaires were used to collect health data. Logistic analysis was used to determine the association between depression score and noise level, negative binomial regression was used to determine potential risks. The geometric mean indoor noise level was 38.9 dB (A), with approximately 40.9% of hotels exceeding the 45 dB value (A). Approximately 19.1% of hotel workers exhibited mild and above depressive symptoms. In addition to functional zoning, geographic location, central air conditioner, decoration status, and other factors had an impact on noise levels (p < 0.05). Results of logistic and negative binomial regression showed the following: (1) there was significantly positive association between indoor noise and high depression scores above 2 (OR = 1.007, 95% CI: 1.002, 1.012) and (2) some sub-groups were more susceptible to this effect, especially for the younger female workers working in the first-tier cities, having higher education level, lower level of income, smoking, and longer working hours. This study confirms an early potential effect of indoor noise on depression. It is recommended to implement evidence-based measures to control noise sources in hotels.

A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study

BACKGROUND

Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru.

METHODS

ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services.

RESULTS

Twenty-eight (11 female, 17 male) ALWH aged 15-21 years participated; n = 20 (71%) identified as heterosexual. Most (18/28) acquired HIV at birth. Baseline PHQ-9 scores were 0-4, n = 3 (11%); 5-9, n = 9 (32%); 10-14, n = 10 (36%); 15-19, n = 4 (14%); and 20-27, n = 2 (7%). Eleven participants (40%) reported SI. Among participants with PHQ-9 > 4, 92% (23/25) were not severe. Of the 21 (75%) of participants eligible for PFA, n = 9 (32%) accepted at least one session, of which n = 3 (33%) were linked to specialized care.

CONCLUSIONS

A simple care pathway operationalizing depression screening and non-specialist delivered emotional support is a first step toward integrated depression and HIV care for ALWH.