Feasibility, Safety, Acceptability, and Preliminary Efficacy of Measurement-Based Care Depression Treatment for HIV Patients in Bamenda, Cameroon

Abstract

Background Depression affects 18-30% of HIV-infected patients in Africa and is associated with greater stigma, lower antiretroviral adherence, and faster disease progression. However, the region's health system capacity to effectively identify and treat depression is limited. Task-shifting models may help address this large mental health treatment gap. Methods Measurement-Based Care (MBC) is a task-shifting model in which a Depression Care Manager (DCM) guides a non-psychiatric (e.g., HIV) provider in prescribing and managing antidepressant treatment. We adapted MBC for depressed HIV-infected patients in Cameroon and completed a pilot study to assess feasibility, safety, acceptability, and preliminary efficacy. Results We enrolled 55 participants; all started amitriptyline 25-50mg daily at baseline. By 12 weeks, most remained at 50mg daily (range 25-125mg). Median (interquartile range) PHQ-9 depressive severity scores declined from 13 (12-16) (baseline) to 2 (0-3) (week 12); 87% achieved depression remission (PHQ9<5) by 12 weeks. Intervention fidelity was high: HIV providers followed MBC recommendations at 96% of encounters. Most divergences reflected a failure to increase dose when indicated. No serious and few bothersome side effects were reported. Most suicidality (prevalence: 62% at baseline; 8% at 12 weeks) was either passive or low-risk. Participant satisfaction was high (100%), and most participants (89%) indicated willingness to pay for medications if MBC were implemented in routine care. Conclusions The adapted MBC intervention demonstrated high feasibility, safety, acceptability, and preliminary efficacy in this uncontrolled pilot study. Further research should assess whether MBC could improve adherence and HIV outcomes in this setting.

Screening and management of mental health and substance use disorders in HIV treatment settings in low‐ and middle‐income countries within the global IeDEA consortium

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Psychological interventions for Common Mental Disorders for People Living With HIV in Low‐ and Middle‐Income Countries: systematic review

“…Other limitations include the strict inclusion criteria which excluded non‐English, unpublished studies and computer‐based studies. Although several studies that were carried out subsequent to this review addressed some of these limitations, they were largely pilot studies that utilised non‐random samples or were uncontrolled and all had sample sizes of <100 .…”

Depression in HIV Infected Patients: a Review

“…However, there is a lack of available data from studies conducted before the advent of highly active antiretroviral therapy and of controlled studies that systematically assess efficacy and safety of some classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications). In particular, overall, there is compelling evidence that the appropriate use of antidepressant medications can improve the quality of life of mentally ill HIV-infected individuals and the adherence to antiretroviral therapy [5, [109][110][111][112]. A recent meta-analysis reviewed 29 studies of the effect of depression treatment on HIV adherence.…”