Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial

Christina Psaros, Amelia M. Stanton, Greer A. Raggio, Nzwakie Mosery, Georgia R. Goodman, Elsa S. Briggs, Marcel Williams, David Bangsberg, Jenni Smit, Steven A. Safren

Research output: Contribution to journalArticlepeer-review

Abstract

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

Original languageEnglish (US)
JournalInternational Journal of Behavioral Medicine
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • Adherence
  • Depression
  • HIV
  • Pregnancy
  • South Africa

ASJC Scopus subject areas

  • Applied Psychology

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