Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial

Psaros, Christina; Stanton, Amelia M.; Raggio, Greer A.; Mosery, Nzwakie; Goodman, Georgia R; Briggs, Elsa S.; Williams, Marcel F.; Bangsberg, David R.; Smit, Jenni; Safren, Steven A.

doi:10.1007/s12529-022-10071-z

Cited by 9 publications

(4 citation statements)

References 75 publications

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“…There was no reduction in the percentage of intervention students with clinical depression compared to the control group. Similarly, a small study focused on reducing depression symptoms, and nonadherence to antiretroviral therapy in pregnant women with HIV in South Africa (RCT, N = 23, some concern) found a significant reduction in depression symptoms compared to TAU, with the results being maintained at the 3-month follow-up [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression

Metz,

Lewis,

Mitchell

et al. 2023

PLoS ONE

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Problem-solving (PS) has been identified as a therapeutic technique found in multiple evidence-based treatments for depression. To further understand for whom and how this intervention works, we undertook a systematic review of the evidence for PS’s effectiveness in preventing and treating depression among adolescents and young adults. We searched electronic databases (PsycINFO, Medline, and Cochrane Library) for studies published between 2000 and 2022. Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13–25 years; (d) at least one depression outcome was reported. Risk of bias of included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A narrative synthesis was undertaken given the high level of heterogeneity in study variables. Twenty-five out of 874 studies met inclusion criteria. The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Twelve studies focused purely on PS; 13 used PS as part of a more comprehensive intervention. Eleven studies found positive effects in reducing depressive symptoms and two in reducing suicidality. There was little evidence that the intervention impacted PS skills or that PS skills acted as a mediator or moderator of effects on depression. There is mixed evidence about the effectiveness of PS as a prevention and treatment of depression among AYA. Our findings indicate that pure PS interventions to treat clinical depression have the strongest evidence, while pure PS interventions used to prevent or treat sub-clinical depression and PS as part of a more comprehensive intervention show mixed results. Possible explanations for limited effectiveness are discussed, including missing outcome bias, variability in quality, dosage, and fidelity monitoring; small sample sizes and short follow-up periods.

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Section: Resultsmentioning

confidence: 99%

Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression

Metz,

Lewis,

Mitchell

et al. 2023

PLoS ONE

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“…For example, elements of a trauma‐focused ART adherence intervention developed for South African women with histories of sexual violence can be leveraged; promising pilot data showed decreases in post‐traumatic stress and increases in ART adherence motivation in the intervention [ 114 ], and a larger randomized controlled trial (RCT) is currently underway (NCT04793217). Similarly, a pilot study of cognitive behaviour therapy (CBT)‐based intervention for ART adherence and depression led to decreased depression among postpartum women with HIV [ 115 ], and a separate RCT demonstrated that a CBT‐based intervention targeting depression improved ART adherence and increased odds of having an undetectable viral load relative to control [ 116 ]. Specific treatment components of these interventions include CBT strategies like problem‐solving [ 117 ], behavioural activation [ 116 ], approach‐oriented coping skills training [ 118 ] and cognitive restructuring [ 116 ].…”

Section: Discussionmentioning

confidence: 99%

The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub‐Saharan Africa: state of the science and research priorities

et al. 2022

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Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.

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“…Several interventions have shown promise in reducing mental health symptoms among HIV-positive populations. In South Africa and Kenya, brief mental health treatment delivered by non-specialists were associated with fewer symptoms of depression, PTSD, and anxiety ( Meffert et al., 2021 ; Psaros et al., 2022 ; Sikkema et al., 2018 ). However, none of these three studies reported measurable gains in ART adherence or viral suppression, perhaps due to the pilot nature of the study samples.…”

Section: Discussionmentioning

confidence: 99%

Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders

Hatcher

Turan

Stöckl

et al. 2022

SSM - Mental Health

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Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial

Cited by 9 publications

References 75 publications

Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression

Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression

The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub‐Saharan Africa: state of the science and research priorities

Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders

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