Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes

Abstract

This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = -0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.

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

“…As implemented, the program did not appear to improve HIV care or depression outcomes, as few patients received depression treatment as intended. Studies in the region have found that similar programs, albeit with higher fidelity to their treatment protocols, have been effective at treating depression [35,36]. In our study, nearly all participants achieved depression remission, regardless of depression treatment.…”

“…In our study, nearly all participants achieved depression remission, regardless of depression treatment. As many of these other evaluations of depression treatment programs were quite small or did not include control arms [35,36], it is possible that depressive symptoms could have improved in the absence of depression treatment. However, it should be noted that we could have overestimated six-month depression remission if patients who did not remain in care were more likely to have persistent depressive symptoms.…”

“…In regards to the program's impact on HIV outcomes, the literature on linking depression treatment to improvements across the HIV care cascade is mixed [13][14][15][16][62][63][64][65][66][67][68][69]. A recent meta-analysis of depression treatment interventions for people living with HIV in sub-Saharan Africa also did not find that interventions improve viral suppression, though they did conclude that the programs with an ART adherence component had the greatest impact on HIV outcomes [36]. As it was impossible for the program to have a pure control group in which patients were denied depression treatment, it is possible that providers discussed the depression screening results with participants or provided brief additional ART adherence counseling.…”

“…Developed over many years of formative research in Zimbabwe, the Friendship Bench is patient-centered counseling that teaches patients how to identify triggers and effectively manage stressful life events by learning or reactivating problem solving skills [29,34]. These programs as well as others have proven efficacy in improving depression outcomes, though evidence on improvements in HIV care outcomes has been mixed [27,[31][32][33][35][36][37]. Further investment in understanding the feasibility of task-shifting program implementation and the effectiveness of these models of depression care is needed to meet the mental health care needs of people living with HIV.…”

Acceptability and Feasibility of Group Interpersonal Therapy (IPT-G) for Depressed HIV+ Postpartum Adolescents Delivered by Community Health Workers: A Protocol Paper

“…2 Poor mental health has also been associated with HIV disease progression independent of its effects on adherence to care. 3 Adolescent mothers have a higher prevalence of postpartum depression than adult mothers, with an estimated prevalence of postpartum depression in adolescent mothers ranging from 26% to 50%. 4 A study from Malawi found that adolescents living with HIV had a depression prevalence of 18.9%.…”