Christina Psaros1,2, Amelia M Stanton3, Greer A Raggio3,4, Nzwakie Mosery5, Georgia R Goodman3,6, Elsa S Briggs7,8, Marcel Williams9, David Bangsberg10, Jenni Smit5, Steven A Safren11. 1. Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA. cpsaros@mgh.harvard.edu. 2. , Boston, USA. cpsaros@mgh.harvard.edu. 3. Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA. 4. National Center for Weight and Wellness, Washington, D.C., USA. 5. MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa. 6. The Fenway Institute, Fenway Health, Boston, MA, USA. 7. Department of Health Systems & Population Health, University of Washington, Seattle, WA, USA. 8. Department of Community Health Science, Boston University, Boston, MA, USA. 9. Howard University College of Medicine, Washington, D.C., USA. 10. OHSU-PSU School of Public Health, Portland, OR, USA. 11. Department of Psychology, University of Miami, Miami, FL, USA.
Abstract
BACKGROUND: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. METHOD: Twenty-three pregnant women with HIV (WWH), ages 18-45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. RESULTS: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β = - 11.1, t(24) = - 3.1, p < 0.005, 95% CI [- 18.41, - 3.83], and 3 months, β = - 13.8, t(24) = - 3.3, p < 0.005, 95% CI [- 22.50, - 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. CONCLUSION: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.
BACKGROUND: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. METHOD: Twenty-three pregnant women with HIV (WWH), ages 18-45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. RESULTS: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β = - 11.1, t(24) = - 3.1, p < 0.005, 95% CI [- 18.41, - 3.83], and 3 months, β = - 13.8, t(24) = - 3.3, p < 0.005, 95% CI [- 22.50, - 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. CONCLUSION: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.
Authors: Brandon A Knettel; Cody Cichowitz; James Samwel Ngocho; Elizabeth T Knippler; Lilian N Chumba; Blandina T Mmbaga; Melissa H Watt Journal: J Acquir Immune Defic Syndr Date: 2018-04-15 Impact factor: 3.731
Authors: Carey Farquhar; James N Kiarie; Barbra A Richardson; Marjory N Kabura; Francis N John; Ruth W Nduati; Dorothy A Mbori-Ngacha; Grace C John-Stewart Journal: J Acquir Immune Defic Syndr Date: 2004-12-15 Impact factor: 3.731
Authors: Sandra M Eldridge; Claire L Chan; Michael J Campbell; Christine M Bond; Sally Hopewell; Lehana Thabane; Gillian A Lancaster Journal: BMJ Date: 2016-10-24
Authors: Steven A Safren; C Andres Bedoya; Conall O'Cleirigh; Katie B Biello; Megan M Pinkston; Michael D Stein; Lara Traeger; Erna Kojic; Gregory K Robbins; Jonathan A Lerner; Debra S Herman; Matthew J Mimiaga; Kenneth H Mayer Journal: Lancet HIV Date: 2016-09-19 Impact factor: 12.767
Authors: Alana Rogers; Shelley Obst; Samantha J Teague; Larissa Rossen; Elizabeth A Spry; Jacqui A Macdonald; Matthew Sunderland; Craig A Olsson; George Youssef; Delyse Hutchinson Journal: JAMA Pediatr Date: 2020-11-01 Impact factor: 16.193
Authors: Pascal Geldsetzer; H Manisha N Yapa; Maria Vaikath; Osondu Ogbuoji; Matthew P Fox; Shaffiq M Essajee; Eyerusalem K Negussie; Till Bärnighausen Journal: J Int AIDS Soc Date: 2016-04-25 Impact factor: 5.396
Authors: M Bridget Spelke; Ravi Paul; Bryan S Blette; Samantha Meltzer-Brody; Crystal E Schiller; J M Ncheka; Margaret P Kasaro; Joan T Price; Jeffrey S A Stringer; Elizabeth M Stringer Journal: J Int AIDS Soc Date: 2022-07 Impact factor: 6.707
Authors: Amelia M Stanton; Conall O'Cleirigh; Lucia Knight; Dvora L Joseph Davey; Landon Myer; John A Joska; Kenneth H Mayer; Linda-Gail Bekker; Christina Psaros Journal: J Int AIDS Soc Date: 2022-10 Impact factor: 6.707