Abstract
Depression is prevalent among people living with HIV in South Africa and interferes with adherence to antiretroviral therapy. This study evaluated a nurse-delivered, cognitive behavioral therapy intervention for adherence and depression among antiretroviral therapy users with depression in South Africa (n = 14). Primary outcomes were depression, antiretroviral therapy adherence, feasibility, and acceptability. Findings support robust improvements in mood through a 3-month follow up. Antiretroviral therapy adherence was maintained during the intervention period. Participant retention supports acceptability; however, modest provider fidelity despite intensive supervision warrants additional attention to feasibility. Future effectiveness research is needed to evaluate this nurse-delivered cognitive behavioral therapy intervention for adherence and depression in this context.
Highlights
Depression is prevalent among people living rates of depression have been found to be 41 perwith HIV (PLWH)
Based on previous quantitative (Andersen, 2009) and qualitative studies (Andersen et al, 2015) conducted by our research team in periurban areas outside Cape Town, we developed an intervention based on Cognitive behavioral therapy (CBT)-AD for delivery using a task-sharing model called Ziphamandla (Empower Yourself)
As a metric of effect size, Cohen’s d was computed for each outcome within subjects from baseline to the last assessment time point (3-month follow up for all outcomes with the exception of Wisepill adherence), accounting for the correlation between means at the two time points. All participants identified their ethnic origin as Xhosa
Summary
Depression is prevalent among people living rates of depression have been found to be 41 perwith HIV (PLWH). In South Africa, where the cent among PLWH (Freeman et al, 2008). Addressing depression in HIV care in South Africa has potential to improve HIV treatment and prevention; it is estimated that only one in four patients with a psychiatric disorder receive appropriate treatment (Seedat et al, 2008). This is in part due to lack of access to specialized mental health providers in South Africa. In a resourceconstrained context, such as South Africa, tasksharing, whereby non-mental health specialists provide mental health services under the supervision of specialists, may be the most feasible approach for delivering mental health services in primary care (Saraceno et al, 2007)
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