The effectiveness of psychoeducation and problem-solving on depression and treatment adherence in adolescents living with HIV in Botswana: an exploratory clinical trial

Abstract

Background This study aimed to explore the effectiveness of psychological interventions (PI): psychoeducation, problem-solving, and rehearsal strategies on depression and adherence in HIV-infected adolescents in Botswana. Methods Fifty adolescents living with HIV were randomized into control (n = 25) and intervention groups (n = 25), the latter being exposed to five weeks of PI sessions. The PHQ-9 and visual analog scale (VAS) were used to measure the outcomes: depression and adherence at pre-intervention, 5- and 24 weeks post-intervention. Results The participants’ mean age (SD) was 17.38 years (1.1), the two groups being similar in socio-demographic variables: gender (χ2 = 2.22; p = 0.135) and age (U = 285, z = − 0.55, p = 0.579). The intervention group scored significantly lower on depressive symptoms (PHQ-9 [F (1,50) = 12.0, p = 0.001, ƞp2 = 0.20]) and higher on adherence score (VAS [F (1,50) = 13.5, p = 0.001, ƞp2 = 0.22]) than the control group after 5 weeks. The post-hoc analysis showed that the significant improvements in depressive symptoms (z = − 4.03, p < 0.01, r [effect size] = 0.88) and adherence (z = − 4.05, p < 0.01, r = 0.88) at post-test in the intervention group were maintained at 24 weeks. This project was registered with ClinicalTrials.gov (NCT05482217). Conclusion The 5-week PI showed promising effectiveness in addressing depression and adherence in adolescents living with HIV in Botswana.

Psychosocial interventions for depression among young people in Sub-Saharan Africa: a systematic review and meta-analysis

“…The twenty-two included studies were conducted across ten different SSA countries; nine in Nigeria [ 54 – 62 ], four in Kenya [ 63 – 66 ], two each in the Democratic Republic of Congo (DRC) [ 67 , 68 ] and South Africa [ 69 , 70 ] and one each in Botswana [ 71 ], Burundi [ 72 ], Mauritius [ 73 ], Rwanda [ 74 ], and Uganda [ 75 ]. Ninteen studies were RCTs, while three were NRSIs.…”

“…While the majority of interventions included the general student population, others targeted specific populations with increased risk of depression such as students with sickle cell disease in Nigeria (SCD) [ 54 ], internally displaced [ 63 ] and students from low-income families in Kenya [ 64 – 66 ], and orphaned students in Rwanda [ 74 ]. Among the non-school-based interventions, three were delivered in clinics to adolescents living with HIV in Botswana [ 71 ], trauma-exposed adolescents in South Africa [ 70 ] and depressed adolescents attending a psychiatric clinic in Nigeria [ 61 ]. The others were delivered in communities to war-affected adolescents in DRC [ 67 , 68 , 75 ] and orphans of the HIV epidemic in South Africa [ 69 ].…”

“…The other interventions combined two psychotherapautic approaches. The Resourceful Adolescent Program (RAP), a universal preventive programme, combined both IPT and CBT techniques [ 73 ] while the intervention by Olashore et al [ 71 ] combined psychoeducation and problem-solving. Table 4 shows the important intervention characteristics of each study.…”

“…Screening instrument modified to fit the context and language (Swahili) Use of local interpreters O'Callaghan et al [ 68 ] Group Trauma-focused CBT (24) Waitlist (28) A manualized Trauma Focused-CBT intervention focusing on psychoeducation, stress management, affect expression and modulation, and cognitive restructuring and coping 15 sessions over five weeks Group. Face to Face Local (Congolese) social workers Cultural adaptations included having a female facilitator talk about ways to reduce the risk of sexual violence (e.g., fetching firewood with a friend); the use of culturally familiar games, songs, and examples (e.g., belief that a neighbour is a witch); and social workers visiting the girl’s guardians to foster family acceptance and reduce stigmatization Screening Instrument modified to Swahili Olashore et al [ 71 ] Psychoeducation and Problem-solving (25) Waitlist (25) The intervention involved interactive discussion, role-play, and brief plenary sessions. It included psychoeducation on HIV, depression, stigma, identifying problems, guided problem-solving, increasing pleasurable activities, mood monitoring, and rehearsing adaptive adherence strategies 1 h weekly sessions for 5 weeks Group.…”

Antiretroviral therapy non-adherence and its relationship with cognitive impairment, alcohol use disorder, and depression in adolescents living with HIV

“…The Visual Analogue Scale (VAS) was used to measure non-adherence, the outcome variable, and has been described in an earlier manuscript [ 20 ]. In this study, the VAS is depicted as a 10 cm long horizontal line, marked in 5 cm increments from 0 to 100.…”