Effectiveness of psychological treatments for depressive symptoms among people living with HIV/AIDS in low- and middle-income countries: A systematic review and meta-analysis

Background: Psychological treatments play a significant role in managing depressive symptoms. However, little is known about the most effective psychological treatments for depressive symptoms for people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). Aims: To identify effective psychological treatments to manage depressive symptoms for adult PLWHA in LMICs and to estimate pooled effect sizes using a meta-analysis. Method: Four databases were searched using key words and MeSH terms - PubMed, Scopus, Cochrane library and PsychINFO. The inclusion criteria were randomized controlled trials (RCTs) that examine psychological treatments that target depressive symptoms for adult PLWHA in LMICs. The Cochrane risk of bias tool was used to assess the risk of bias. A meta-analysis was done using RevMan-5. Result: Nineteen studies were included in the systematic review and 14 of them were selected for meta-analysis. Eight (42%) of the trials used cognitive behavioural therapy (CBT). Pooled effect size of trials that used continuous outcomes was -0.61 (n = 12, 95%CI: -1.24, 0.02, I-2 = 95%) at post-treatment assessment. The pooled effect size changed to -1.41 (n = 8, 95%CI: -2.54, -0.28, I-2 = 98%) at six months post treatment. Limitations: Studies varied in quality from low to high risk of bias and there was high heterogeneity across studies. Conclusion: Trials used group support psychotherapy, interpersonal therapy, problem-solving therapy, and peer-support counselling were effective in reducing depressive symptoms. However, better powered studies with more consistent methodologies are needed to investigate whether specific therapies delivered by lay counsellors are effective for PLWHA in LMICs.