Project Lead(s): Etheldreda Nakimuli-Mpungu
Studies have shown that depression may interfere with the ability to acquire and/or use information about HIV/AIDS and its treatment regimens.
Early recognition and treatment of depression would lead to better uptake of behaviour change messages, decrease HIV transmission risk behaviours and enhance adherence to anti-retroviral therapy (ART), which may result in improved clinical effectiveness of ART regimens.
The World Health Organization recommends psychological therapies as first-line treatments for depression but they are non-existent in northern Uganda.
The goal of the project was to develop and test a culturally sensitive group support psychotherapy (GSP) intervention to treat and prevent depression in HIV patients.
A randomized controlled trial (RCT) of the GSP for depressed HIV-infected adults was conducted in post-conflict northern Uganda, comparing GSP with Group HIV education (GHE) among people living with HIV/AIDS.
Men and women (n = 109) living with HIV, aged 18 and older, meeting the Mini International Neuropsychiatric Interview [MINI] criteria for major depression, were recruited from an urban HIV care centre in Kitgum district, northern Uganda.
Participants were stratified by gender and randomized to receive either eight weekly sessions of GSP (n = 57) or eight weekly sessions of GHE (n = 52) and were followed up at post-intervention and for six months thereafter.
The primary outcomes were the level of depressive symptoms and functioning. Secondary outcomes were perceived social support and self-esteem.
Participants in the GSP study arm recorded a significantly greater reduction in depression symptoms compared with those in the GHE arm at the six-month assessment.
The rate of increase in function scores was also greater among GSP participants than GHE participants, both during treatment and at six months post intervention.
GSP participants had significantly higher function scores and self-esteem scores at six months post intervention. These results were published in the Lancet HIV journal (http://bit.ly/2hyGKHH).
The successful development and implementation of this group support psychotherapy program enabled project partners, the Peter C. Alderman Foundation (PCAF), to secure more funds from Foundation d’Harcourt (www.fondationdharcourt.org/) for community outreach mental health services, including group support psychotherapy.
The intervention is now being implemented in HIV clinics situated in government primary care health facilities in three northern Uganda districts (Gulu,Kitgum and Pader) Implementation activities include training health workers in these HIV clinics to screen persons living with HIV for depression and to offer group support psychotherapy as a first-line treatment for the depression. The trained health workers will, in turn, train lay people in the villages (faith healers, traditional healers expert clients, linkage facilitators and members of the village health team) to acquire the skills needed to recognize depression and treat it with delivered group support psychotherapy.
The project activities were accepted by the Mental Health Innovation Network repository of innovations and have been uploaded to their website.