The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

Stockton, Melissa; Udedi, Michael; Kulisewa, Kazione; Hosseinipour, Mina C.; Mphonda, Steven M.; Maselko, Joanna; Pettifor, Audrey; Verhey, Ruth; Chibanda, Dixon; Lapidos‐Salaiz, Ilana; Pence, Brian W.

doi:10.1371/journal.pone.0231872

Cited by 43 publications

(64 citation statements)

References 64 publications

(112 reference statements)

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“…The study’s total sample size ranged from 32 to 1140, intervention sample sizes ranged from 19 to 578 and control group sample sizes ranged from 13 to 562. The majority of studies (n = 22, 73.33 %) reported on interventions for depression [33‐55]. Major depressive disorder was confirmed using diagnostic interviews such as SCID or MINI in three studies [34‐36].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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Introduction Addressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low‐ and middle‐income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness. Methods We included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full‐text screening for references meeting title/abstract criteria. Results We identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post‐traumatic stress disorder (n = 1, 3.33%) and HIV‐related neuro‐cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = −1.56, 95% CI = −3.03 to −0.09, p = 0.037]. Conclusions There continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low‐ and middle‐income countries.

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Section: Resultsmentioning

confidence: 99%

“…Other pharmacological interventions had no benefit over placebo. This review also revealed a single study which evaluated fluoxetine in combination with problem‐solving therapy where the intervention did not have significant effects [43].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…Elevated depressive symptoms suggesting a high risk of a depressive disorder (hitherto described as "depression") was defined as a PHQ-9 score ≥ 5 at ART initiation, following the definition in the parent study [40]. We also consider a 3-level categorical depressive severity measure (0-4, 5-9, and ≥ 10, corresponding to no, mild, and moderate to severe depression, respectively).…”

Section: Depression At Art Initiationmentioning

confidence: 99%

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

et al. 2020

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As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

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“…9 This was supported by previous literature in which HIV patients who were stable and on ART may have benefited from intervention by healthcare workers that lead to decreased HIV related stressors over time. 9,15,32,33 Indeed, it is necessary to provide ongoing mental health monitoring of HIV patients at different levels of the healthcare intervention, and special emphasis is recommended for those newly identified HIV positive people.…”

Section: Discussionmentioning

confidence: 99%

Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses

et al. 2021

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Background: Although there is a high burden of HIV in sub-Saharan Africa (SSA), studies on mental health issues among people living with HIV are scarce. The study addressed the transition to “test and treat” guidelines for HIV, which makes it unique regarding its evaluation of psychological distress amongst newly initiated people living with HIV in the test and treat era. Methods: We conducted a cross-sectional survey of 689 people newly diagnosed with HIV. Symptoms of psychological distress were measured using the Kessler-10 psychological distress assessment scale. Factors associated with psychological distress were captured using interviewer-administered questionnaires. Ordinal logistic regression analyses were employed to identify predictors of psychological distress. Results: The magnitude of psychological distress was 58.63% (95% CI = 55.2%-62.3%). The severity of the psychological distress of which, 17.42% had severe distress. Psychological distress was observed more among female patients (β = 0.47, AOR = 1.59, 95% CI = 1.12, 2.27), patients presented with opportunistic infections (β = 0.50, AOR = 1.65, 95% CI = 1.03, 2.66) and being non-working functional status (β = 0.99, AOR = 2.70, 95% CI = 1.64, 4.45). Moreover, patients who were malnourished (β = 0.46, AOR = 1.58, 95% CI = 1.09, 2.26), having good level of knowledge on HIV prevention (β = 0.59, 95% CI = 0.55, 0.39, 0.78), presented with sexually transmitted infection (β = 0.48, AOR = 1.61, 95% CI = 1.01, 2.58), history of alcohol use (β = 0.44, AOR = 1.55, 95% CI = 1.09, 2.21), perceived stigma (β = 0.08, AOR = 1.09 95% CI = 1.04, 1.15) and treated in health centers (β = 0.55, AOR = 1.74, 95% CI = 1.25, 2.41) had higher odds of psychological distress. Conclusion: The large majority of newly diagnosed HIV patients suffered from psychological distress. An increased vulnerability was observed among females, those with opportunistic and sexually transmitted infections, those having poor functional status and malnourished. Furthermore, HIV patients treated in health centers, those who had history of alcohol use and patients with high level of HIV related stigma are more negatively affected by the HIV diagnosis. Hence, all intervention strategies should target all the identified predictors.

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The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

Cited by 43 publications

References 64 publications

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

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

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses

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