Effects of M-DEPTH Model of Depression Care on Maternal HIV Viral Suppression and Adherence to the PMTCT Care Continuum Among HIV-Infected Pregnant Women in Uganda: Results from a Cluster Randomized Controlled Trial at Pregnancy Completion.

Journal: AIDS and behavior

Volume: 27

Issue: 9

Year of Publication: 2023

Affiliated Institutions:  RAND Corporation, Main Street, Santa Monica, CA, , USA. gwagner@rand.org. Makerere University, School of Public Health, Kampala, Uganda. RAND Corporation, Main Street, Santa Monica, CA, , USA. College of Health Sciences, Makerere University, Kampala, Uganda. Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda. Butabika National Referral Mental Hospital, Kampala, Uganda. Ministry of Health, Kampala, Uganda. Mildmay Uganda, Kampala, Uganda.

Abstract summary 

Perinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the prevention of mother-to-child transmission (PMTCT) care continuum; therefore, treating perinatal depression may result in increased viral suppression and PMTCT adherence. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on depression, maternal viral suppression and adherence to PMTCT care processes in an ongoing cluster-randomized controlled trial of 391 HIV-infected pregnant women (200 usual care; 191 intervention) with at least mild depressive symptoms enrolled across 8 antenatal care clinics in Uganda. At baseline, 68.3% had clinical depression and 41.7% had detectable HIV viral load. Adjusted repeated-measures multivariable regression models found that the intervention group was nearly 80% less likely to be clinically depressed [Adjusted OR (95% CI) 0.22 (0.05, 0.89)] at the 2-month post-pregnancy assessment, compared to the control group. However, the intervention and control groups did not differ meaningfully on maternal viral suppression, ART adherence, and other PMTCT care processes and outcomes. In this sample of women who were mostly virally suppressed and ART adherent at baseline, the depression care model had a strong effect on depression alleviation, but no downstream effects on viral suppression or other PMTCT care processes.Trial Registration NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).

Authors & Co-authors:  Wagner Glenn J GJ Gwokyalya Violet V Faherty Laura L Akena Dickens D Nakigudde Janet J Ngo Victoria V McBain Ryan R Ghosh-Dastidar Bonnie B Beyeza-Kashesya Jolly J Nakku Juliet J Kyohangirwe Leticia L Nabitaka Linda Kisaakye LK Lukwata Hafsa H Mukasa Barbara B Wanyenze Rhoda K RK

Study Outcome 

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Statistics
Citations :  Audureau E, Kahn JG, Besson M-H, Saba J, Ladner J. Scaling up prevention of mother-to-child HIV transmission programs in sub-Saharan African countries: a multilevel assessment of site-, program- and country-level determinants of performance. BMC Public Health. 2013;13(1):286. doi: 10.1186/1471-2458-13-286.
Authors :  15
Identifiers
Doi : 10.1007/s10461-023-04014-2
SSN : 1573-3254
Study Population
Women,Female
Mesh Terms
Female
Other Terms
Adherence;HIV;PMTCT;Perinatal depression;Problem solving therapy;Uganda;Viral suppression;antidepressants
Study Design
Randomized Control Trial,Case Control Trial,Cross Sectional Study
Study Approach
Country of Study
Uganda
Publication Country
United States