Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status

Abstract

The objective of the study was to assess the effectiveness of group counseling, using a problem-solving therapy approach, on reducing depressive symptoms and increasing prenatal disclosure rates of HIV status among HIV-positive pregnant women living in Dar es Salaam, Tanzania. A randomized controlled trial was performed comparing a six-week structured nurse-midwife facilitated psychosocial support group with the standard of care. Sixty percent of women in the intervention group were depressed post-intervention, versus 73% in the control group [Relative Risk (RR) = 0.82, 95% confidence interval (CI): 0.67-1.01, p=0.066]. HIV disclosure rates did not differ across the two study arms. However, among those women who disclosed, there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88%) compared to the control group (62%; p=0.004). The results indicate reductions in the level of depressive symptoms comparable with major depressive disorder (MDD) for HIV-positive pregnant women participating in a group counseling intervention. Although the psychosocial group counseling did not significantly increase disclosure rates, an improvement in the level of personal satisfaction resulting from disclosure was associated with the intervention. This suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure. Public agencies and non-governmental organizations working in Tanzania and similar settings should consider offering structured psychosocial support groups to HIV-positive pregnant women to prevent poor mental health outcomes, promote early childhood development, and potentially impact HIV-related disease outcomes in the long term.

Mental Health of HIV-Seropositive Women During Pregnancy and Postpartum Period: A Comprehensive Literature Review

“…Eighteen publications from studies conducted in Zimbabwe [16, 17], Angola [18], Zambia [19], South Africa [20–28], Tanzania [29–31], Kenya [32] and Nigeria [33] met the review eligibility criteria. Fifteen of these 18 publications reported on depressive symptoms or other mental health-related outcomes such as distress, anxiety or coping mechanisms [16–22, 25–32], two studies focused on IPV and pregnant HIV+ women [23, 33] and one study examined substance abuse in pregnant HIV+ women [24].…”

“…Four of these studies were clinical trials which evaluated interventions designed to improve mental health outcomes in pregnant HIV+ women. [25, 26, 30, 31]…”

“…Of the four clinical trials included in this review, two were randomized controlled trials (RCTs) conducted in Tanzania [30, 31] and two were quasi-experimental clinical trials conducted in South Africa [25, 26]. Three of these trials evaluated psychosocial interventions, and one evaluated efficacy of nutritional supplements in improving mental health and psychosocial outcomes of pregnant HIV+ women.…”

Quality of HIV Counselling in South Africa

“…3 Haffejee et al 2010;Cornman et al 2011;Kaaya et al 2013). Such counselling interventions are preferred and relevant compared to the didactic, informational approaches.…”

Concealment, communication and stigma: The perspectives of HIV-positive immigrant Black African men and their partners living in the United Kingdom

“…Disclosure can open up access to psychosocial support (Kaaya et al, 2013), but it can also introduce risks of social rejection, violence (Maman et al, 2014) disrupted interpersonal relationships, irreversible family role changes and discrimination (McDermott, 2006). Disclosure creates uncertainty about potential responses, since the person who discloses sensitive personal information cannot predict the meanings that the recipients will give to it (AlegrÍa, 2010).…”