Interpersonal psychotherapy delivered by nonspecialists for depression and posttraumatic stress disorder among Kenyan HIV–positive women affected by gender-based violence: Randomized controlled trial

Abstract

Background HIV–positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world’s majority of HIV–positive women live and prevalence of GBV is high. Methods and findings We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV–positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months. Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03). Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (−6.9 [−12.2, −1.5], p = 0.01), and nonsignificantly reduced work absenteeism (−3.35 [−6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (−2.79 [−5.42, −0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed. Conclusions IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV–positive women’s mental health, functioning, and GBV (IPV) exposure, compared to controls. Trial registration Clinical Trials Identifier NCT02320799.

Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations

“…A pilot trial in Egypt among Sudanese refugees reported decreased depression and PTS symptoms among its participants [ 41 ]. There is additional evidence that supports efficacy among GBV survivors—an RCT in Kenya among HIV-positive women affected by GBV reported support for both the content and structure of a group IPT intervention, as well as its feasibility [ 42 , 43 ]. Given its effectiveness in treating depression, the WHO has released an adapted and translated manual for group IPT, and recommend it as a “first-line” treatment for depression [ 44 ].…”

Psychosocial interventions for depression delivered by non-mental health specialists to people living with HIV/AIDS in low- and middle-income countries: A systematic review

“…We reviewed the full text of 287 potentially eligible studies and excluded 272 studies (Appendix S2 in the Online Supplementary Document ). We ultimately included 15 studies [ 14 - 16 , 21 - 32 ] which corresponded to 14 RCTs.…”

“…Four trials were pilot studies [ 21 , 23 , 27 , 28 ]. There were eleven parallel RCTs [ 14 - 16 , 21 , 26 - 32 ], one stepped-wedge RCT [ 22 ], one full factorial RCT [ 23 ], one three-arm RCT [ 25 ]. Six studies were conducted in China [ 14 , 21 , 25 , 26 , 30 , 31 ], two in South Africa [ 16 , 28 ], one in Tanzania [ 22 ], one in Argentina [ 23 ], one in Uganda [ 15 ], one in India [ 27 ] and two in Kenya [ 29 , 32 ].…”

“…There were eleven parallel RCTs [ 14 - 16 , 21 , 26 - 32 ], one stepped-wedge RCT [ 22 ], one full factorial RCT [ 23 ], one three-arm RCT [ 25 ]. Six studies were conducted in China [ 14 , 21 , 25 , 26 , 30 , 31 ], two in South Africa [ 16 , 28 ], one in Tanzania [ 22 ], one in Argentina [ 23 ], one in Uganda [ 15 ], one in India [ 27 ] and two in Kenya [ 29 , 32 ]. Eleven trials were conducted in urban areas or a mixture of urban and rural [ 14 , 16 , 21 - 23 , 25 , 28 - 32 ], whilst three [ 15 , 26 , 27 ] were carried out in rural areas.…”

Scaling up public mental health care in Sub-Saharan Africa: insights from infectious disease

“…Meffert et al . ( 2021 ). b Electronic Medical Records (EMR) in public sector primary care are robust in many SSA regions, partly associated with the implementation of the continuum of HIV care (Haskew et al ., 2015 ; Kang'a et al ., 2017 ).…”