Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa.

Journal: AIDS and behavior

Volume: 22

Issue: 1

Year of Publication: 2019

Affiliated Institutions:  Health Service & Population Research Department, Centre for Public Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO , De Crespigny Park, London, SE AF, UK. melanie.abas@kcl.ac.uk. College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe. Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe. Parirenyatwa General Hospital, Harare, Zimbabwe. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. Health Service & Population Research Department, Centre for Public Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO , De Crespigny Park, London, SE AF, UK. Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. Department of Psychology, University of Miami, Miami, FL, USA.

Abstract summary 

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire-4.7 points in PST-AD arm vs. control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.

Authors & Co-authors:  Abas Melanie M Nyamayaro Primrose P Bere Tarisai T Saruchera Emily E Mothobi Nomvuyo N Simms Victoria V Mangezi Walter W Macpherson Kirsty K Croome Natasha N Magidson Jessica J Makadzange Azure A Safren Steven S Chibanda Dixon D O'Cleirigh Conall C

Study Outcome 

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Statistics
Citations :  UNAIDS. Fact Sheet 2016. 2016.
Authors :  14
Identifiers
Doi : 10.1007/s10461-016-1659-4
SSN : 1573-3254
Study Population
Male,Female
Mesh Terms
Adult
Other Terms
Adherence;Depression;Intervention;Problem solving;Sub-Saharan Africa
Study Design
Study Approach
,Qualitative
Country of Study
Zimbabwe
Publication Country
United States