Potential for psychological programmes for mental disorders among people living with HIV: further studies necessary in sub-Saharan Africa

Psychological interventions for common mental disorders for people living with HIV in low- and middle-income countries: systematic review.

Chibanda D, Cowan FM, Healy JL, Abas M, Lund C. Trop Med Int Health. 2015 Mar 7. doi: 10.1111/tmi.12500. [Epub ahead of print]

Objective: To assess the effectiveness of structured psychological interventions against common mental disorders (CMD) in people living with HIV infection (PLWH), in low- and middle-income countries (LMIC).

Methods: Systematic review of psychological interventions for CMD from LMIC for PLWH, with two-stage screening carried out independently by 2 authors.

Results: Of 190 studies, 5 met inclusion criteria. These were randomised-controlled trials based on the principles of cognitive behaviour therapy (CBT) and were effective in reducing CMD symptoms in PLWH. Follow-up of study participants ranged from 6 weeks to 12 months with multiple tools utilised to measure the primary outcome. Four studies showed a high risk of bias, while 1 study from Iran met low risk of bias in all 6 domains of the Cochrane risk of bias tool and all 22 items of the CONSORT instrument.

Conclusion: There is a need for more robust and adequately powered studies to further explore CBT-based interventions in PLWH. Future studies should report on components of the psychological interventions, fidelity measurement and training, including supervision of delivering agents, particularly where lay health workers are the delivering agent.

Abstract   Full-text [free] access

Editor’s notes: Common mental disorders (CMD) including depression and anxiety, are highly prevalent among people living with HIV and contribute to poor HIV outcomes, including treatment failure. However, the lack of mental health professionals in many low- and middle-income countries means that lay health workers can play an important role in treating CMD. This has been well-documented from non-HIV settings, but not among people living with HIV. This systematic review found that few studies have rigorously evaluated the effectiveness of psychological programmes for CMD among people living with HIV (and only one from sub-Saharan Africa), but all of these reported benefits in the activity arm compared to the control arm. This suggests that further, large, well-designed trials are necessary to evaluate such activities especially in countries most severely affected by HIV in southern and eastern Africa. Key points raised by this review include the need for locally validated tools to assess mental health outcomes in future trials. The importance of formative work to develop and finalise the programme for the trial setting, including local stakeholders, systems for assessing the fidelity of the activity, and a referral or supervision plan, is ever more emphasized.  

Africa, Asia
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