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

被引:11
作者
Psaros, Christina [1 ]
Stanton, Amelia M. [1 ]
Raggio, Greer A. [1 ,2 ]
Mosery, Nzwakie [3 ]
Goodman, Georgia R. [1 ,4 ]
Briggs, Elsa S. [5 ,6 ]
Williams, Marcel [7 ]
Bangsberg, David [8 ]
Smit, Jenni [3 ]
Safren, Steven A. [9 ]
机构
[1] Harvard Med Sch, Dept Psychiat, Massachusetts Gen Hosp, Boston, MA 02115 USA
[2] Natl Ctr Weight & Wellness, Washington, DC USA
[3] Univ Witwatersrand, Fac Hlth Sci, Dept Obstet & Gynaecol, MatCH Res Unit MRU, Durban, South Africa
[4] Fenway Hlth, Fenway Inst, Boston, MA USA
[5] Univ Washington, Dept Hlth Syst & Populat Hlth, Seattle, WA USA
[6] Boston Univ, Dept Community Hlth Sci, Boston, MA USA
[7] Howard Univ, Coll Med, Washington, DC USA
[8] OHSU PSU Sch Publ Hlth, Portland, OR USA
[9] Univ Miami, Dept Psychol, Miami, FL USA
关键词
South Africa; HIV; Depression; Pregnancy; Adherence; COGNITIVE-BEHAVIORAL THERAPY; ACTIVE ANTIRETROVIRAL THERAPY; ANTENATAL DEPRESSION; MENTAL-HEALTH; PRENATAL DEPRESSION; PREGNANT-WOMEN; POSTPARTUM PERIOD; SOCIAL SUPPORT; POSITIVE WOMEN; RISK-FACTORS;
D O I
10.1007/s12529-022-10071-z
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
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, beta = - 11.1, t(24) = - 3.1, p < 0.005, 95% CI [- 18.41, - 3.83], and 3 months, beta = - 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.
引用
收藏
页码:62 / 76
页数:15
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