The acceptability of antidepressant treatment in people living with HIV in Malawi

A patient perspective

Bibliographic Data

ID15540935
AuthorsKazione Kulisewa (0000-0002-2979-4495, Kamuzu Central Hospital, corresponding author), Caroline Minnick (0000-0003-1177-9307, University of North Carolina at Chapel Hill), Melissa A Stockton (0000-0002-0737-7180, University of North Carolina at Chapel Hill), Bradley N Gaynes (0000-0002-8283-5030, University of North Carolina at Chapel Hill), Mina C Hosseinipour (0000-0003-2174-313X, University of North Carolina at Chapel Hill), Steven M Mphonda (University of Malawi), Griffin Sansbury (0000-0003-1558-7994, University of Malawi), Michael Udedi (0000-0001-8769-4313, Ministry of Health), Brian W Pence (0000-0001-7321-9538, University of North Carolina at Chapel Hill)
Year2023
Volume18
Issue1
Pages2201327-2201327
Publication date2023-01-02
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueGlobal Public Health (JOURNAL)
Journal identifiersISSN: 1744-1692 • E-ISSN: 1744-1706
PublisherTaylor & Francis (PUBLISHER • GB)
DOI10.1080/17441692.2023.2201327
PMID37088107
OpenAlexW4366808681
LanguageEN
Citations received1
References cited28

Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depression in sub-Saharan Africa. We conducted in-depth interviews from June to December 2018 with eleven patients enrolled in Project SOAR-Mental Health, a pilot project integrating depression treatment into HIV care in Malawi. Patients treated with amitriptyline or fluoxetine participated in interviews exploring antidepressant acceptability through patient knowledge, side effect severity, pill burden, adherence, perceived efficacy, and tolerability. Patients described a lack of detailed antidepressant education from their providers. Variable, typically self-limiting side effects were reported from both amitriptyline and fluoxetine. While most side effects were mild, three patients reported functional impairment. Patients reported high adherence, though the additional pill burden was a challenge. Most patients found the antidepressants efficacious, tolerable, beneficial and acceptable. Although patient psychoeducation is notably lacking as a facet of clinical management, antidepressant prescription by primary care providers appears acceptable for comorbid severe depression in PLWH initiating HIV care in sub-Saharan Africa. Health workers should be mindful of dosing to minimise side effects and considerate of the additional pill burden. Trial registration: ClinicalTrials.gov ID [NCT03555669]. Retrospectively registered on 13 June 2018

Adverse effect · Antidepressant · Depression (economics · Fluoxetine · Medical prescription · Mental health · Pill · Psychiatry · Sertraline · Tolerability · Family Caregiving in Mental Illness · HIV/AIDS Research and Interventions · Maternal Mental Health During Pregnancy and Postpartum · Medicine · Nursing · Internal Medicine