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Zani, Babalwa, Fairall, Lara, Petersen, Inge, Folb, Naomi, Bhana, Arvin, Hanass-Hancock, Jill, Selohilwe, One, Petrus, Ruwayda, Georgeu-Pepper, Daniella, Mntambo, Ntokozo, Kathree, Tasneem, Carmona, Sergio, Lombard, Carl J., Lund, Crick, Levitt, Naomi, Bachmann, Max O. 
ORCID: https://orcid.org/0000-0003-1770-3506 and Thornicroft, Graham
(2025)
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 of Affective Disorders, 370.
pp. 499-510.
ISSN 0165-0327
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Abstract
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).
| Item Type: | Article |
|---|---|
| Additional Information: | Data availability statement: The de-identified data set and a data dictionary will be made available after publication of the trial after obtaining relevant Institutional Research Ethics Board approval of a proposal and signed data access agreement. Funding Information: The research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH100470. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This study is also an output of the PRogramme for Improving Mental health carE-SA (PRIME) and was supported by the UK Department for International Development [201446]. The views expressed do not necessarily reflect the UK Government's official policies. LF is supported by the UK‘s National Institute of Health Research (NIHR) using Official Development Assistance (ODA) funding (NIHR Global Health Research Unit on Health Systems Strengthening in Sub-Saharan Africa at King's College London (16/136/54)). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care, England. GT is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College London NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. GT also receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (CobALT study). GT is also supported by the UK Medical Research Council in relation the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. BZ received partial funding by the South African Medical Research Council through the Division of Research Capacity Development under the Researcher Development Grant. The contents thereof are the sole responsibility of the authors and does not necessarily represent the official views of the SAMRC. |
| Uncontrolled Keywords: | hiv,depression,collaborative care,antiretroviral therapy,viral load suppression,psychosocial counselling,psychiatry and mental health,clinical psychology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2738 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Population Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 25 Oct 2024 08:30 |
| Last Modified: | 29 Nov 2024 01:52 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/97193 |
| DOI: | 10.1016/j.jad.2024.10.061 |
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