JMIR Publications

ABSTRACT

Background:

Psychosocial characteristics including self-esteem, perceived social support, coping skills, stigma, discrimination and poverty are strongly correlated with depression symptoms. However, data on the extent of these correlations among persons living with HIV, and the correlations between psychosocial characteristics and HIV treatment outcomes is limited in sub-Saharan Africa.

Objective:

This paper aims to describe the recruitment and correlations among baseline characteristics of a sample of HIV positive men and women in a cluster randomized trial designed to examine the effects of group support psychotherapy delivered by trained lay health workers for depression treatment.

Methods:

Thirty eligible primary care health centers across three districts were randomly allocated to have their lay health workers trained to deliver group support psychotherapy (intervention arm) or group HIV education and treatment as usual (control arm) to PLWH with depression. Screening and recruitment procedures were documented. Baseline demographic, socio-economic and psychosocial characteristics were collected via interviewer administered questionnaires. Among eligible participants, differences between those enrolled versus those who refused enrollment were assessed using Chi-square for categorical variables and t-tests for continuous variables.Spearman rank-order correlation analyses were conducted to determine associations between baseline depression symptoms, adherence to antiretroviral therapy (ART), viral load suppressionand other psychosocial variables.

Results:

The study screened 1,473 people of which 1,140 were eligible and enrolled over a 14 week recruitment period. Participants recruited comprised of 95% of the target sample size of 1,200. The sample mean age was 38.46(SD=10.97) and both genders were well represented (males 46.32%). Most participants met diagnostic criteria for major depressive disorder (96.9%), had significant post-traumatic stress symptoms (72.54%), reported moderate suicide risk (52.54%), primary or no formal education (86.23%), lack of income generating activity (70%), and food insecurity (81.87%). Baseline mean scores for disability days in the past month, functioning, self-esteem, and social support were low while mean scores for internalized stigma were high.Among eligible participants, 48(4.2%) refused to participate in the interventions and these were more likely to be males (χ2 =4.01; p-value =0.045) and have significantly lower depression symptoms scores (t =2.36; p-value =0.01) than those who enrolled and participated in the interventions. Several significant positive and negative correlations were found between psychosocial variables and depression. There was a significant positive correlation between viral load suppression and number of trauma events experienced (ρ = 0.12, p < 0.05). Adherence to ART was positively correlated with perceived social support (ρ = 0.15, p < 0.01) but negatively correlated with depression symptoms (ρ = -0.11, p < 0.05) and stigma (ρ = - 0.14, p < 0.01).

Conclusions:

In this study population, men and womenwith HIV and major depression are vulnerable on multiple levels and disadvantaged across many social and economic determinants of health. Therefore, psychological therapy to support these individuals should be tailored to the cultural context, and have the ingredients to address not only multiple emotional problems but also the socio-economic disadvantage. Clinical Trial: This trial is registered with The Pan African Clinical Trials Registry; PACTR201608001738234.