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

Abstract

Background Depression, 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. Methods This 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. Discussion We 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 registration ClinicalTrials.gov ID [ NCT03555669 ]. Retrospectively registered on 13 June 2018.

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

“…However, the launch of the intervention phase was staggered, launching at Clinic A in November 2017 and at Clinic B in April 2018. (Fig 1) Additional information on the study design is available in the published protocol paper [41]. https://doi.org/10.1371/journal.pone.0231872.g001…”

“…The MOH has also prioritized the integration of mental health services into other general health services and the development of mental health capacity of general providers [38][39][40]. Expanding the growing nidus of investment in mental health care programming and capacity development, the MOH implemented a pilot program integrating depression management into HIV care at two public clinics in Lilongwe, Malawi, using both algorithm-guided depression treatment and adapted Friendship Bench therapy [41]. Inspired by the key principles of implementation science, we use a multiple-baseline design to investigate the program's impact on HIV care and depression outcomes.…”

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

“…We defined viral suppression as a viral load < 1000 copies/mL drawn at least 5 and a half months (166 days) after starting ART, following the 2018 Malawian ART guidelines. Viral load testing was performed at Bwaila Hospital in Lilongwe using collected plasma or dried blood spots and processed by Abbott m2000 RealTime HIV-1 assay instruments [ 41 ].…”

A Mixed-Methods Process Evaluation: Integrating Depression Treatment Into HIV Care in Malawi

“…As such, the HIV providers were to continue screening and treating patients according to the Friendship Bench and MBC protocols after the conclusion of the study evaluation. Previous publications provide further details on the program design, 16 implementation, 17 and impact. 20 …”

“…To address the burden of depression among people living with HIV, the Malawi Ministry of Health (MOH) implemented a pilot task-shifting program that integrated depression management into ART initiation at 2 clinics in Lilongwe, Malawi. 16 , 17 As part of this program, existing clinic-based staff provided 2 evidence-based depression treatment interventions: measurement-based care (MBC) antidepressant prescription 10 , 15 , 18 and the Friendship Bench problem-solving therapy. 14 , 19 Early assessments of program delivery demonstrated the feasibility of integrating depression screening into ART initiation and starting patients on antidepressants or Friends Bench therapy.…”