The effectiveness of depression management for improving HIV care outcomes in Malawi: protocol for a quasi-experimental study

Michael Udedi,Mina C Hosseinipour,Steven M Mphonda,Melissa A Stockton,Bradley N Gaynes,Kazione Kulisewa,Brian W Pence

doi:10.1186/s12889-019-7132-3

Abstract

BackgroundDepression, prevalent among people living with HIV (PLWH) in Malawi, is associated with negative HIV patient outcomes and likely affects HIV medical management. Despite the high prevalence of depression, its management has not been integrated into HIV care in Malawi or most low-income countries.MethodsThis study employs a pre-post design in two HIV clinics in Lilongwe, Malawi, to evaluate the effect of integrating depression management into routine HIV care on both mental health and HIV outcomes. Using a multiple baseline design, this study is examining mental health and HIV outcome data of adult (≥18 years) patients newly initiating ART who also have depression, comparing those entering care before and after the integration of depression screening and treatment into HIV care. The study is also collecting cost information to estimate the cost-effectiveness of the program in improving rates of depression remission and HIV treatment engagement and success.DiscussionWe anticipate that the study will generate evidence on the effect of depression management on HIV outcomes and the feasibility of integrating depression management into existing HIV care clinics. The results of the study will inform practice and policy decisions on integration of depression management in HIV care clinics in Malawi and related settings, and will help design a next-step strategy to scale-up integration to a larger scale.Trial registrationClinicalTrials.gov ID [NCT03555669]. Retrospectively registered on 13 June 2018.

Highlights

Depression, prevalent among people living with Human Immunodeficiency Virus (HIV) (PLWH) in Malawi, is associated with negative HIV patient outcomes and likely affects HIV medical management
The United Nations Programme on HIV/AIDS (UNAIDS) plan, which has been embraced by the international public health community and much of subSaharan Africa, calls for 90% of those HIV-infected to be aware of their status, 90% of those aware of their status to be on sustained antiretroviral therapy (ART), and 90%
Retention in HIV care has been challenging, with only 76% of adults initiating ART being retained in care at 12 months, and only 65% being both retained in care and virally suppressed [14]

Summary

Introduction

Depression, prevalent among people living with HIV (PLWH) in Malawi, is associated with negative HIV patient outcomes and likely affects HIV medical management. The UNAIDS plan, which has been embraced by the international public health community and much of subSaharan Africa, calls for 90% of those HIV-infected to be aware of their status, 90% of those aware of their status to be on sustained antiretroviral therapy (ART), and 90%. Comorbid depression affects patients receiving ART [7] as it is a barrier to ART retention [8, 9], associated with reduced ART adherence and viral suppression [7, 10,11,12]. Depression is prevalent among HIV-infected adults in Malawi [15, 16] and is associated with decreased retention in care and viral suppression [7,8,9,10,11,12, 17,18,19,20]. The MoH is working to build capacity through task-sharing approaches, including training primary care providers and outreach workers in mental health screening and counselling [22,23,24]

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