Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa

Bibliographic Data

ID15338892
AuthorsMelanie Abas (0000-0003-1716-5584, King's College London, corresponding author), Primrose Nyamayaro (0000-0002-6856-1002, University of Zimbabwe), Tarisai Bere (University of Zimbabwe), Emily Saruchera (University of Zimbabwe), Nomvuyo Mothobi (Parirenyatwa Hospital), Victoria Simms (0000-0001-5664-6810, London School of Hygiene & Tropical Medicine), Walter Mangezi (0000-0002-8889-0487, University of Zimbabwe), Kirsty Macpherson (King's College London), Natasha Croome (0000-0002-0248-0437, King's College London), Jessica F Magidson (0000-0002-3513-3255, Harvard University), Jessica Magidson, Tariro Makadzange (0000-0001-5330-1470, Harvard University), Azure Makadzange, Steven A Safren (0000-0002-0121-0806, University of Miami), Steven Safren, Dixon Chibanda (0000-0003-2505-8607, University of Zimbabwe), Conall O’cleirigh (0000-0002-5639-5043, Harvard University)
Year2017
Volume22
Issue1
Pages86-101
Publication date2017-01-06
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAIDS and Behavior (JOURNAL)
Journal identifiersISSN: 1090-7165 • E-ISSN: 1573-3254
PublisherSpringer Science+Business Media (PUBLISHER • DE)
DOI10.1007/s10461-016-1659-4
PMID28063075
OpenAlexW2569438986
LanguageEN
Citations received25
References cited47

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire-4.7 points in PST-AD arm vs. control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD

Attendance · Clinical trial · Depression (economics · Family medicine · Health psychology · Human immunodeficiency virus (HIV · Physical therapy · Psychiatry · Public health · Qualitative research · Randomized controlled trial · Viral load · Child and Adolescent Psychosocial and Emotional Development · Clinical Psychology · HIV/AIDS Research and Interventions · Medicine · Mental Health Treatment and Access · Nursing · Internal Medicine