Long-Term Effect of Group Support Psychotherapy on Depression and HIV Treatment Outcomes

Secondary Analysis of a Cluster Randomized Trial in Uganda

Bibliographic Data

ID19306844
AuthorsEtheldreda Nakimuli‐Mpungu (0000-0001-6857-8931, Gulu University, corresponding author), Etheldreda Nakimuli-Mpungu, Colin M Smith (0000-0002-5758-4698, Gulu University), Kizito Wamala (0000-0003-4800-7052, Gulu University), James Okello (0000-0003-2634-3063, Gulu University), Josephine Birungi (0000-0002-6557-5089, Gulu University), Micheal Etukoit (Gulu University), Ramin Mojtabai (0000-0002-2134-4043, Gulu University), Jean B Nachega (0000-0002-2862-4443, Gulu University), Ofir Harari (0000-0002-2901-0558, Gulu University), Seggane Musisi (0000-0002-3454-0000, Gulu University), Edward J Mills (0000-0003-3120-9694, Gulu University)
Year2022
Volume84
Issue8
Pages914-923
Publication date2022-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePsychosomatic Medicine (JOURNAL)
Journal identifiersISSN: 0033-3174 • E-ISSN: 1534-7796
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/psy.0000000000001128
PMID36162067
OpenAlexW4297097696
LanguageEN
Citations received6
References cited60

OBJECTIVE: We aimed to determine the effect of group support psychotherapy (GSP) compared with group HIV education (GHE) on depression and HIV treatment outcomes 24 months after treatment. We further aimed to investigate the mediating role of depression and antiretroviral therapy (ART) adherence in the relationship between GSP and viral load suppression. METHODS: Thirty HIV clinics across three districts were randomly assigned to deliver either GSP or GHE for depression. Depression and optimal (≥95%) ART adherence was assessed at baseline and 6, 12, 18, and 24 months after treatment. Viral load was drawn from the medical charts at baseline and 12 and 24 months after treatment. Multilevel mixed-effects regression models and generalized structural equation modeling were used to estimate 24-month outcomes and mediation effects. RESULTS: Participants ( N = 1140) were enrolled from HIV clinics offering either GSP ( n = 578 [51%]) or GHE ( n = 562 [49%]). Fewer GSP than GHE participants met the criteria for depression at 24 months after treatment (1% versus 25%; adjusted odds ratio [aOR] = 0.002, 95% confidence interval [CI] = 0.0002-0.018). More GSP than GHE participants reported optimal (≥95%) ART adherence (96% versus 88%; aOR = 20.88, 95% CI = 5.78-75.33) and improved viral suppression (96% versus 88%; aOR = 3.38, 95% CI = 1.02-11.02). The indirect effects of GSP through sequential reduction in depression and improvement in ART adherence at 12 months may partially explain the higher viral suppression rates at 24 months in GSP than GHE groups. CONCLUSION: In settings where the HIV epidemic persists, depression treatment with GSP may be critical for optimal HIV treatment outcomes.Trial Registration: The Pan African Clinical Trials Registry, number PACTR201608001738234

Confidence interval · Depression (economics) · Generalized estimating equation · Human immunodeficiency virus (HIV) · Odds ratio · Psychiatry · Randomized controlled trial · Viral load · Adolescent Sexual and Reproductive Health · Bipolar Disorder and Treatment · HIV/AIDS Research and Interventions · Immunology · Internal Medicine · Medicine