Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries

Abstract

People living with HIV (PLWH) experience greater psychological distress than the general population. Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms, quality of life, and HIV care engagement. However, little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries (LMICs), where the large majority of PLWH reside. This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these settings. A systematic search strategy was undertaken to identify peer-reviewed published papers of intervention trials addressing negative psychological states or disorders (e.g. depression, anxiety) among PLWH in LMIC settings. Search results were assessed against pre-established inclusion and exclusion criteria. Data from papers meeting criteria were extracted for synthesis. Twenty-six papers, published between 2000 and 2014, describing 22 unique interventions were identified. Trials were implemented in sub-Saharan Africa (n = 13), Asia (n = 7), and the Middle East (n = 2), and addressed mental health using a variety of approaches, including cognitive-behavioral (n = 18), family-level (n = 2), and pharmacological (n = 2) treatments. Four randomized controlled trials reported significant intervention effects in mental health outcomes, and 11 preliminary studies demonstrated promising findings. Among the limited mental health intervention trials with PLWH in LMICs, few demonstrated efficacy. Mental health interventions for PLWH in LMICs must be further developed and adapted for resource-limited settings to improve effectiveness.

RETRACTED: Developing a Model to Implement National Mental Health Policy Framework and Integration of Mental Health care into HIV Services at Primary Health Care Settings

“…Mental disorders in these settings are often untreated due to a lack of, pre-and post-counselling as well as pharmacological treatment opportunities (Petersen & Lund, 2011;World Health Organization, 2001). The cited authors recommend that policies about the integration of mental health into primary health care must be developed and be communicated well to the policy implementers for the effective and successful integration of these services (Chibanda et al, 2014;Mayston et al, 2012;Sikkema et al, 2015).…”

Screening and management of mental health and substance use disorders in HIV treatment settings in low‐ and middle‐income countries within the global IeDEA consortium

“…Evidence‐based management for many MSDs significantly improves mental health outcomes . Integration of evidence‐based interventions to manage MSDs into HIV care has been identified as a promising strategy to improve mental health and HIV treatment outcomes of PLWHA in LMICs . The World Health Organization (WHO) recommends integration of or linkage to mental health services for PLWHA, where possible, and has developed the Mental Health Gap Action Programme (mhGAP) to provide evidence‐based guidelines for the diagnosis and management of priority mental health disorders in routine healthcare settings .…”

Opportunities and challenges to Integrating mental health into HIV programs in a Low- and Middle-Income Country: Insights from the Nigeria Implementation Science Alliance

“…Different integrative, task-sharing approaches involving lay health workers have been used to deliver antidepressants in Cameroon (17), to provide psychosocial interventions to PLHIV in South Africa (14), for problem solving therapy for depression and common mental disorders in Zimbabwe (21), and to improve lay health workers' knowledge and self-e cacy in managing mental disorders in Malawi (22). The integrated care approach is a promising, acceptable and feasible strategy for improving both mental health and HIV treatment outcomes in low and middle-income countries (LMIC) (23)(24)(25). However these approaches to integrate HIV and mental health services remain limited by research gaps in cost-effectiveness and long-term impact of different models on patient outcomes and by barriers to their adoption in LMIC (25).…”