TY - JOUR
T1 - Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa
T2 - A pragmatic cluster randomised controlled trial
AU - Zani, Babalwa
AU - Fairall, Lara
AU - Petersen, Inge
AU - Folb, Naomi
AU - Bhana, Arvin
AU - Hanass-Hancock, Jill
AU - Selohilwe, One
AU - Petrus, Ruwayda
AU - Georgeu-Pepper, Daniella
AU - Mntambo, Ntokozo
AU - Kathree, Tasneem
AU - Carmona, Sergio
AU - Lombard, Carl
AU - Lund, Crick
AU - Levitt, Naomi
AU - Bachmann, Max
AU - Thornicroft, Graham
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/2/1
Y1 - 2025/2/1
N2 - Background: HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. Methods: We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). Results: The intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = −0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. Limitations: The highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. Conclusion: The trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registration: ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).
AB - Background: HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. Methods: We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). Results: The intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = −0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. Limitations: The highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. Conclusion: The trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registration: ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).
KW - Antiretroviral therapy
KW - Collaborative care
KW - Depression
KW - HIV
KW - Psychosocial counselling
KW - Viral load suppression
UR - http://www.scopus.com/inward/record.url?scp=85209081755&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2024.10.061
DO - 10.1016/j.jad.2024.10.061
M3 - Article
C2 - 39442695
AN - SCOPUS:85209081755
SN - 0165-0327
VL - 370
SP - 499
EP - 510
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -
