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Tytuł pozycji:

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.

Tytuł:
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.
Autorzy:
Stockton MA; Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Udedi M; NCDs & Mental Health Unit, Ministry of Health, Lilongwe, Malawi.; Department of Mental Health, University of Malawi, College of Medicine, Blantyre, Malawi.
Kulisewa K; Department of Mental Health, University of Malawi, College of Medicine, Blantyre, Malawi.
Hosseinipour MC; University of North Carolina Project-Malawi, Tidziwe Centre, Lilongwe, Malawi.; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
Gaynes BN; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
Mphonda SM; University of North Carolina Project-Malawi, Tidziwe Centre, Lilongwe, Malawi.
Maselko J; Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Pettifor AE; Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Verhey R; Friendship Bench Zimbabwe, Milton Park, Harare, Zimbabwe.
Chibanda D; Friendship Bench Zimbabwe, Milton Park, Harare, Zimbabwe.
Lapidos-Salaiz I; United States Agency for International Development (USAID), Arlington, VA, United States of America.
Pence BW; Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Źródło:
PloS one [PLoS One] 2020 May 06; Vol. 15 (5), pp. e0231872. Date of Electronic Publication: 2020 May 06 (Print Publication: 2020).
Typ publikacji:
Controlled Clinical Trial; Journal Article; Multicenter Study; Research Support, U.S. Gov't, Non-P.H.S.
Język:
English
Imprint Name(s):
Original Publication: San Francisco, CA : Public Library of Science
MeSH Terms:
Delivery of Health Care*/methods
Delivery of Health Care*/organization & administration
Anti-Retroviral Agents/*therapeutic use
Depression/*diagnosis
HIV Infections/*drug therapy
HIV Infections/*psychology
Mass Screening/*organization & administration
Adult ; Antidepressive Agents/therapeutic use ; Depression/complications ; Depression/epidemiology ; Depression/therapy ; Feasibility Studies ; Female ; HIV ; HIV Infections/complications ; HIV Infections/epidemiology ; Humans ; Implementation Science ; Malawi/epidemiology ; Male ; Mass Screening/methods ; Mental Health ; Patient Participation/statistics & numerical data ; Pilot Projects ; Program Evaluation ; Psychotherapy/methods ; Psychotherapy/organization & administration ; Remission Induction ; Systems Integration ; Treatment Outcome ; Viral Load/drug effects ; Young Adult
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Grant Information:
P2C HD050924 United States HD NICHD NIH HHS; T32 MH096724 United States MH NIMH NIH HHS; United States PEPFAR PEPFAR
Substance Nomenclature:
0 (Anti-Retroviral Agents)
0 (Antidepressive Agents)
Entry Date(s):
Date Created: 20200507 Date Completed: 20200728 Latest Revision: 20231112
Update Code:
20240105
PubMed Central ID:
PMC7202614
DOI:
10.1371/journal.pone.0231872
PMID:
32374724
Czasopismo naukowe
Background: Depression is highly prevalent among patients newly starting antiretroviral treatment (ART) in Malawi and many other countries. Untreated depression at ART initiation can disrupt the HIV care continuum. Effective approaches for depression screening and treatment exist for low-resource settings, but they are rarely applied. Identifying effective implementation strategies are critical.
Methods: A pilot program integrated depression screening and treatment into routine HIV care using existing staff at two public health clinics in Malawi in two phases; a screening-only "control" phase and an active "intervention" phase. During the intervention phase, providers prescribed antidepressants or referred patients for Friendship Bench problem-solving therapy. We evaluated the program's impact on retention in HIV care, viral suppression, and depression remission at 6 months using tabular comparisons and log-binomial models to estimate adjusted risk ratios and mean differences among the intervention group relative to the control group.
Results: Nearly all consenting participants were screened for depression appropriately and 25% had mild to severe depressive symptoms. During the intervention phase, 86% of participants with mild depressive symptoms started Friendship Bench therapy and 96% of participants with moderate to severe depressive symptoms started antidepressants. Few participants in the intervention group received consistent depression treatment over their first 6 months in care. In the adjusted main analysis, program exposure did not demonstrably affect most HIV or mental health outcomes, though the probability of currently being on ART at 6 months was significantly lower among the intervention group than the control group [RR 0.6(95%CI: 0.4-0.9)].
Conclusions: While it is feasible to integrate depression screening and treatment initiation into ART initiation, providing ongoing depression treatment over time is challenging. Similar implementation science studies focused on maintaining depression management will be increasingly important as we strive to understand and test the best ways to implement evidence-based depression treatment within HIV care.
Competing Interests: The authors have declared that no competing interests exist.
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