TY - JOUR
T1 - Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa
T2 - A Pilot Randomized Controlled Trial
AU - Psaros, Christina
AU - Stanton, Amelia M.
AU - Raggio, Greer A.
AU - Mosery, Nzwakie
AU - Goodman, Georgia R.
AU - Briggs, Elsa S.
AU - Williams, Marcel
AU - Bangsberg, David
AU - Smit, Jenni
AU - Safren, Steven A.
N1 - Publisher Copyright:
© 2022, International Society of Behavioral Medicine.
PY - 2023/2
Y1 - 2023/2
N2 - Background: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. Method: Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. Results: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β = − 11.1, t(24) = − 3.1, p < 0.005, 95% CI [− 18.41, − 3.83], and 3 months, β = − 13.8, t(24) = − 3.3, p < 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. Conclusion: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. Trial Registration: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.
AB - Background: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. Method: Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. Results: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β = − 11.1, t(24) = − 3.1, p < 0.005, 95% CI [− 18.41, − 3.83], and 3 months, β = − 13.8, t(24) = − 3.3, p < 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. Conclusion: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. Trial Registration: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.
KW - Adherence
KW - Depression
KW - HIV
KW - Pregnancy
KW - South Africa
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U2 - 10.1007/s12529-022-10071-z
DO - 10.1007/s12529-022-10071-z
M3 - Article
AN - SCOPUS:85125933489
SN - 1070-5503
VL - 30
SP - 62
EP - 76
JO - International Journal of Behavioral Medicine
JF - International Journal of Behavioral Medicine
IS - 1
ER -