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: A pragmatic cluster randomised controlled trial.
Journal: Journal of affective disorders
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Affiliated Institutions:
Knowledge Translation Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Electronic address: babalwa.zani@uct.ac.za.
Knowledge Translation Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Knowledge Translation Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Health Systems Research Unit, South African Medical Research Council, Durban, South Africa.
Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa; School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Department of Molecular Medicine and Haematology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.
Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Cape Town, South Africa.
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Centre for Global Mental Health, Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Centre for Global Mental Health, Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Abstract summary
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.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).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.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.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.ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).
Authors & Co-authors:
Zani Babalwa B
Fairall Lara L
Petersen Inge I
Folb Naomi N
Bhana Arvin A
Hanass-Hancock Jill J
Selohilwe One O
Petrus Ruwayda R
Georgeu-Pepper Daniella D
Mntambo Ntokozo N
Kathree Tasneem T
Carmona Sergio S
Lombard Carl C
Lund Crick C
Levitt Naomi N
Bachmann Max M
Thornicroft Graham G
Study Outcome
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