Efficacy of a multilevel intervention on the mental health of people living with HIV and their family members in rural China.

Li, Li; Ji, Guoping; Liang, Li‐Jung; Lin, Chunqing; Hsieh, Julie; Lan, Chiao-Wen; Xiao, Yunhua

doi:10.1037/hea0000503

Cited by 10 publications

(28 citation statements)

References 36 publications

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“…Eight of the designed interventions [46–49, 53–56] had been piloted and evaluated at a small scale while the other three articles [50–52] described the process of developing the intervention.…”

Section: Resultsmentioning

confidence: 99%

“…Four of the studies [46, 47, 53, 54] did not have age limitations for the PLHIV and enrolled any other household member aware of the HIV status of the PLHIV to complete the dyad. Two studies [49, 51] were individual-based interventions, focusing on the PLHIV in the household (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies [49, 51] were individual-based interventions, focusing on the PLHIV in the household (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…Other household-focused interventions were dedicated to promoting mental health among PLHIV and their affected household members. Li et al [47, 49] described two multi-level family-focused interventions to improve the mental health (depressive symptoms) of both the PLHIV and their family members.…”

Section: Resultsmentioning

confidence: 99%

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Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

et al. 2019

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BackgroundHIV remains a major public health challenge in many low- and middle-income countries (LMICs). The initiation of a greater number of people living with HIV (PLHIV) onto antiretroviral therapy (ART) following the World Health Organization’s ‘universal test and treat’ recommendation has the potential to overstretch already challenged health systems in LMICs. While various mainstream and community-based care models have been implemented to improve the treatment outcomes of PLHIV, little effort has been made to harness the potential of the families or households of PLHIV to enhance their treatment outcomes. To this end, we sought to explore the characteristics and effectiveness of household-focused interventions in LMICs on the management of HIV as measured by levels of adherence, viral suppression and different dimensions of HIV competence. Additionally, we sought to explore the mechanisms of change to explain how the interventions achieved the expected outcomes.MethodsWe systematically reviewed the literature published from 2003 to 2018, obtained from six electronic databases. We thematically analysed the 11 selected articles guided by the population, intervention, comparison and outcome (PICO) framework. Following the generative causality logic, whereby mechanisms are postulated to mediate an intervention and the outcomes, we applied a mechanism-based inferential reasoning, retroduction, to identify the mechanisms underlying the interventions to understand how these interventions are expected to work.ResultsThe identified HIV-related interventions with a household focus were multi-component and multi-dimensional, incorporating aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health. Most of the interventions sought to empower and stimulate self-efficacy while strengthening the perceived social support of the PLHIV. Studies reported a significant positive impact on improving various aspects of HIV competent household – positive effects on HIV knowledge, communication between household members, and improved mental health outcomes of youths living in HIV-affected households.ConclusionBy aiming to strengthen the perceived social support and self-efficacy of PLHIV, household-focused HIV interventions can address various aspects of household HIV competency. Nevertheless, the role of the household as an enabling resource to improve the outcomes of PLHIV remains largely untapped by public HIV programmes; more research on improving household HIV competency is therefore required.Trial registrationPROSPERO registration: CRD42018094383.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Two studies [49, 51] were individual-based interventions, focusing on the PLHIV in the household (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

et al. 2019

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“…Therefore, to improve the effectiveness of the care delivered to Chinese HIV-infected women, it is critical to include in the care these contextual factors, in particular family relationships (Eller et al, 2010). A recent study has shown, with effective family intervention provided to HIV-infected individuals, both care burden and depressive symptoms were decreased in family caregivers and the HIV-infected individuals in China (Li, Ji, et al, 2017). Empowering HIV-affected families appears to be an effective method to reduce mental distress and enhance family support.…”

Section: Introductionmentioning

confidence: 99%

Quality of life in HIV-infected Chinese women and their family caregivers:an intervention study

et al. 2018

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China is experiencing a rapid increase in the number of HIV-infected women. In this study, we describe the development and preliminary evaluation of an intervention tailored for Chinese HIV-infected women and caregivers to improve their self- and family management, with goals of enhancing their physical quality of life (QOL) and decreasing their depressive symptomatology. Forty-one HIV-infected women and their caregivers were recruited from two premier Chinese hospitals from July 2014 through March 2016. Participants were randomized to either the control or intervention arm for the Self- and Family Management Intervention (SAFMI). Each study dyad in the intervention arm received three counseling sessions with a nurse interventionist. At baseline, immediate post-intervention (month 1) and follow-up (month 3), the participants were assessed by a self-reported survey. Generalized Hierarchical Linear Modeling was used to evaluate the efficacy of the intervention. Chinese HIV-infected women in the intervention arm had significantly higher probability of higher physical QOL at month 1 and lower probability of clinically meaningful depressive symptomatology at month 3 compared with women in the control arm. In contrast, the effects of the intervention were less salient for caregivers. This study represents one of the first in China to include family caregivers in HIV management. Feasibility and acceptability were high, in that family members were willing to join the study, learn about HIV, and practice new skills to support the HIV-infected women in their lives. A larger trial is needed to fully evaluate this intervention which shows promising preliminary effects in promoting physical QOL and decreasing depressive symptomatology among Chinese HIV-infected women.

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Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries

Purgato,

Prina,

Ceccarelli

et al. 2023

Cochrane Database of Systematic Reviews

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Background There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. Objectives To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low‐ and middle‐income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. Selection criteria Randomized controlled trials (RCTs) of primary‐level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. Data collection and analysis Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random‐effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post‐intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. Main results Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta‐analyses) for inclusion. Nineteen RCTs were conducted in low‐income countries, 27 in low‐middle‐income countries, 2 in middle‐income countries, 58 in upper‐middle‐income countries and 7 in mixed settings. Eighty‐three RCTs included adults and 30 RCTs included children. Cadres of primary‐level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate‐', 'low‐', or 'very low‐'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post‐intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared...

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Efficacy of a multilevel intervention on the mental health of people living with HIV and their family members in rural China.

Cited by 10 publications

References 36 publications

Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

Quality of life in HIV-infected Chinese women and their family caregivers:an intervention study

Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries

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