Mental health interventions for persons living with HIV in low‐ and middle‐income countries: a systematic review

Nakimuli-Mpungu, Etheldreda; Musisi, Seggane; Smith, Colin M.; Isenburg, Megan von; Akimana, Benedict; Shakarishvili, A; Nachega, Jean B.; Mills, Edward J.; Chibanda, Dixon; Ribeiro, Marcelo M.; Williams, Anna; Joska, John A.

doi:10.1002/jia2.25722

Cited by 32 publications

(23 citation statements)

References 60 publications

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“…The prevalence of global depression in PLWH was 31% based on screening instruments, which ranged from 22% in Europe to 44% in South America [ 6 ]. In addition, some low- and middle-income regions reported a prevalence of depression higher than 30% [ 7 ]. The prevalence of anxiety in PLWH varies due to different study designs and sample sizes; however, it is widely believed that the prevalence of anxiety ranges from approximately 19 to 49%, compared to a twelve-month prevalence of 18% and a lifetime prevalence of 29% in general population [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring bridge symptoms in HIV-positive people with comorbid depressive and anxiety disorders

et al. 2022

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Background The prevalence of comorbid depressive and anxiety disorders in people living with HIV (PLWH) is high. However, it is unclear which symptom is the bridge symptom between depression and anxiety in PLWH. This study aimed to develop symptom networks for depression and anxiety and explore the bridge symptoms and interconnectedness between these disorders in PLWH with comorbid depressive and anxiety disorders. Methods A multisite, hospital-based cross-sectional study was conducted from March 2020 to November 2021. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale. We visualized the symptom network using the qgraph package and computed the bridge expected influence of each node. The GLASSO layout was used to generate undirected association networks. Results A total of 2016 individuals were included in the analysis. In the anxiety cluster, “not feeling relaxed” had the highest bridge expected influence and strength (rbridge expected influence = 0.628, rstrength = 0.903). In the depression cluster, “not feeling cheerful” was identified as having a high bridge expected influence (rbridge expected influence = 0.385). “Not feeling cheerful” and “not feeling relaxed” were the strongest edges across the depression and anxiety clusters (r = 0.30 ± 0.02). Conclusions Healthcare professionals should take note when PLWH report severe bridge symptoms. To enhance the levels of perceived cheerfulness and relaxation, positive psychology interventions could be implemented.

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Section: Introductionmentioning

confidence: 99%

Exploring bridge symptoms in HIV-positive people with comorbid depressive and anxiety disorders

et al. 2022

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“…This trial is unique for several reasons. Firstly, despite robust evidence highlighting the adverse impact of sexual trauma on HIV treatment adherence and care engagement, we have not identified any full-scale randomized controlled trials demonstrating the effectiveness of trauma-focused psychological and behavioral interventions to improve biological outcomes in South Africa, or other low-and middle-income countries (LMIC) [89,90]. This study aims to determine whether a mental health intervention to reduce avoidant coping and traumatic stress in comparison to a high-quality control intervention condition can improve clinical HIV outcomes, including viral suppression (primary outcome) and ART adherence and HIV care engagement (secondary outcomes).…”

Section: Discussionmentioning

confidence: 99%

ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial

Sikkema

Rabie

King

et al. 2022

Trials

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Background Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. Methods This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). Discussion This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.

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“…However, the existing literature has several limitations. First, few studies have explored the long-term effects of mHealth interventions [ 12 - 14 ]. A recent systematic review and meta-analysis included 14 randomized controlled trials (RCTs) of mHealth interventions for reducing depressive symptoms among people living with HIV [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term Effects of a Social Media–Based Intervention (Run4Love) on Depressive Symptoms of People Living With HIV: 3-Year Follow-up of a Randomized Controlled Trial

Guo¹,

Li²,

Yu³

et al. 2022

J Med Internet Res

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Background Emerging studies have shown the effectiveness of mobile health (mHealth) interventions in reducing depressive symptoms among people living with HIV. Most of these studies included only short-term follow-up, with limited data on long-term effects. Objective The purpose of this study is to assess the long-term effects of a randomized controlled trial called Run4Love on depressive symptoms among people living with HIV at 1-year and 3-year follow-ups. Methods A total of 300 people living with HIV with depressive symptoms were recruited and randomized to an intervention or a control group in Guangzhou, China, from September 2017 to January 2018. The intervention group received a 3-month Run4Love program, including adapted evidence-based cognitive behavioral stress management courses and exercise promotion via WeChat (Tencent), a popular social media app. The control group received usual care and a brochure on nutrition. The primary outcome was reduction in depressive symptoms, measured using the Center for Epidemiological Studies–Depression (CES-D) scale. Data used in this study were collected at baseline and at the 1-year and 3-year follow-ups. Generalized estimating equations were used to examine the group differences at 1-year and 3-year follow-ups. Results Approximately half of the participants completed the assessment at 1-year (149/300, 49.7%) and 3-year (177/300, 59%) follow-ups. At 1-year follow-up, participants in the intervention group reported significant reduction in depressive symptoms compared with the control group (CES-D: from 23.9 to 18.1 in the intervention group vs from 24.3 to 23.3 in the control group; mean −4.79, SD 13.56; 95% CI −7.78 to −1.81; P=.002). At 3-year follow-up, between-group difference in CES-D remained statistically significant (from 23.9 to 20.5 in the intervention group vs from 24.3 to 24.4 in the control group; mean −3.63, SD 13.35; 95% CI −6.71 to −0.54; P=.02). No adverse events were reported during the 3-year follow-up period. Conclusions The mHealth intervention, Run4Love, significantly reduced depressive symptoms among people living with HIV, and the intervention effects were sustained at 1-year and 3-year follow-ups. Further research is needed to explore the mechanisms of the long-term effects of mHealth interventions such as Run4Love and to implement these effective interventions among people living with HIV. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR-IPR-17012606 International Registered Report Identifier (IRRID) RR2-10.2196/10274

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Mental health interventions for persons living with HIV in low‐ and middle‐income countries: a systematic review

Cited by 32 publications

References 60 publications

Exploring bridge symptoms in HIV-positive people with comorbid depressive and anxiety disorders

Exploring bridge symptoms in HIV-positive people with comorbid depressive and anxiety disorders

ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial

Long-term Effects of a Social Media–Based Intervention (Run4Love) on Depressive Symptoms of People Living With HIV: 3-Year Follow-up of a Randomized Controlled Trial

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