Maternal depression treatment in HIV (M-DEPTH)

Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic stress symptoms at higher rates than their male counterparts and more often than HIV-unaffected women. These mental health issues affect not only the well-being and quality of life of WLWH, but have implications for HIV management and transmission prevention. Despite these ramifications, WLWH are under-treated for mental health concerns and they are underrepresented in the mental health treatment literature. In this review, we illustrate the unique mental health issues faced by WLWH such as a high prevalence of physical and sexual abuse histories, caregiving stress, and elevated internalized stigma as well as myriad barriers to care. We examine the feasibility and outcomes of mental health interventions that have been tested in WLWH including cognitive behavioral therapy, mindfulness-based interventions, and supportive counseling. Future research is required to address individual and systemic barriers to mental health care for WLWH.

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“…This study will incorporate a stepped up care continuum with psychotherapeutic and psychopharmacologic interventions including SSRIs. 153 …”

Section: Mental Health Treatment For Women Living With Hivmentioning

confidence: 99%

Mental Health in Women Living With HIV: The Unique and Unmet Needs

Waldron

Burnett-Zeigler

Wee

et al. 2021

J Int Assoc Provid AIDS Care

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“…In the present study, 82% of intervention participants achieved HIV care retention but only 49% achieved both HIV care retention and depression remission, suggesting that for some participants, the intervention was successful in improving HIV care engagement even without fully resolving mental health symptoms. Several larger cluster randomized trials of interventions to address depressive symptoms and engagement in HIV care outcomes for WLHIV are currently being conducted that may help to shed light on the impact of treating depressive symptoms on both mental health and retention in HIV care outcomes [ 49 – 51 ].…”

Section: Discussionmentioning

confidence: 99%

An Intervention to Improve Mental Health and HIV Care Engagement Among Perinatal Women in Malawi: A Pilot Randomized Controlled Trial

Bengtson

Filipowicz

Mphonda³

et al. 2023

AIDS Behav

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Perinatal depression (PND) is common and an important barrier to engagement in HIV care for women living with HIV (WLHIV). Accordingly, we adapted and enhanced The Friendship Bench, an evidence-based counseling intervention, for perinatal WLHIV. In a pilot randomized trial (NCT04143009), we evaluated the feasibility, acceptability, fidelity, and preliminary efficacy of the Enhanced Friendship Bench (EFB) intervention to improve PND and engagement in HIV care outcomes. Eighty pregnant WLHIV who screened positive for PND symptoms on the Self-Report Questionnaire (≥ 8) were enrolled, randomized 1:1 to EFB or usual care, and followed through 6 months postpartum. Overall, 100% of intervention participants were satisfied with the intervention and 93% found it beneficial to their overall health. Of 82 counseling sessions assessed for fidelity, 83% met or exceeded the fidelity threshold. At 6 months postpartum, intervention participants had improved depression remission (59% versus 36%, RD 23%, 95% CI 2%, 45%), retention in HIV care (82% versus 69%, RD 13%, -6%, 32%), and viral suppression (96% versus 90%, RD 7%, -7%, 20%) compared to usual care. Adverse events did not differ by arm. These results suggest that EFB intervention should be evaluated in a fully powered randomized trial to evaluate its efficacy to improve PND and engagement in HIV care outcomes for WLHIV. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-023-04070-8.

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“…The articles covered 8 LMIC across SSA including; Gambia (San lippo et al, 2019), Ghana (Okronipa et al, 2018) Forms of adaptation also covered who delivered the service and where these services were delivered (Castro et al, 2004) Uganda, peer mothers were trained to deliver problem-solving therapy to individuals as part of a package of therapeutic and pharmaceutical intervention for HIV positive women (Wagner et al, 2019). The only study to be delivered by a specialist professional group-psychiatric nurses-was the Tanzanian study targeting HIV positive women (Kaaya et al, 2013).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of the targeted interventions, two "risk" pro les were targeted; HIV positive women(Kaaya et al, 2013;Wagner et al, 2019) and adolescent mothers(Gureje et al, 2020). Of the 2 studies targeting HIV positive mothers, one targeted women demonstrating minor depressive symptoms(Wagner et al, 2019) whilst the second targeted all HIV positive pregnant women(Kaaya et al, 2013). Both interventions were delivered at facility level, integrated with PMTCT services.…”

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confidence: 99%

“…The two interventions that included pharmaceutical approaches are in the context of HIV services for PMTCT. Prevalence of depression in this group tends to be signi cantly higher(Chibanda et al, 2014;Wagner et al, 2019) perhaps requiring enhanced treatment interventions to be able to effectively reduce symptoms. The study from Tanzania demonstrates that a pharmaceutical approach did not show a signi cant impact on levels of depression among HIV positive women when comparing a group based therapy to standard care for HIV positive women in the prenatal period(Kaaya et al, 2013).…”

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confidence: 99%

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Maternal Mental Health in Sub-Saharan Africa: A Systematic Review of Interventions for Common Perinatal Mental Health Disorders

Woodhead

Marley

Calia

et al. 2023

Preprint

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Introduction Common Perinatal Mental Disorders affect women and children across the world. Rates are high in sub-Saharan Africa, however studies on interventions are limited. Highlighting existing and upcoming practice to support maternal mental health services is imperative. Method We conducted a systematic review, yielding a large array of papers covering 32 low- and lower-middle income countries across sub-Saharan Africa. No time limit was placed on publication and study protocols and results papers were included. Results Twelve articles from 8 different countries were included in our review; Gambia, Ghana, Kenya, Malawi, Nigeria, Tanzania, Uganda and Zimbabwe. Most interventions took a psychotherapeutic approach, two included a pharmaceutical component. Half the studies detailed adapted approaches to ensure cultural acceptance. Effectiveness was limited; 3 studies showed a significant impact, only one of which had a large effect size. Conclusion Evidence remains limited and efforts should be made to support the implementation and generation of evidence in a wide variety of countries and contexts. Task-shifting was a common approach, though services were delivered at health facility level rather than in communities. Scaling-up effective holistic approaches to maternal mental health and child wellbeing remains an area of need.

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Maternal depression treatment in HIV (M-DEPTH)

Cited by 15 publications

References 49 publications

Mental Health in Women Living With HIV: The Unique and Unmet Needs

Mental Health in Women Living With HIV: The Unique and Unmet Needs

An Intervention to Improve Mental Health and HIV Care Engagement Among Perinatal Women in Malawi: A Pilot Randomized Controlled Trial

Maternal Mental Health in Sub-Saharan Africa: A Systematic Review of Interventions for Common Perinatal Mental Health Disorders

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