title: Changes in HIV Outcomes Following Depression Care in a Resource-Limited Setting: Results from a Pilot Study in Bamenda, Cameroon.
abstract: BACKGROUND
  Little is known about how improved depression care affects HIV-related outcomes in Africa. In a sample of depressed HIV patients in a low income, sub-Saharan country, we explored how implementing measurement-based antidepressant care (MBC) affected HIV outcomes over 4 months of antidepressant treatment.
  
  
  METHODS
  As part of a project adapting MBC for use in Cameroon, we enrolled 41 depressed HIV patients on antiretroviral therapy in a pilot study in which a depression care manager (DCM) provided an outpatient HIV clinician with evidence-based decision support for antidepressant treatment. Acute depression management was provided for the first 12 weeks, with DCM contact every 2 weeks and HIV clinician appointments every 4 weeks. We measured HIV clinical and psychiatric outcomes at 4 months.
  
  
  RESULTS
  Participants were moderately depressed at baseline (mean Patient Health Questionnaire [PHQ] score = 14.4, range 13.1, 15.6). All HIV clinical outcomes improved by four month follow-up: mean (range) CD4 count improved from 436 (2, 860) to 452 (132, 876), mean (range) log-viral load decreased from 4.02 (3.86, 4.17) to 3.15 (2.81, 3.49), the proportion with virologic suppression improved from 0% to 18%, mean (range) HIV symptoms decreased from 6.4 (5.5, 7.3) to 3.1 (2.5, 3.7), the proportion reporting good or excellent health improved from 18% to 70%, and the proportion reporting any missed ARV doses in the past month decreased from 73% to 55%. Concurrently, psychiatric measures improved. The mean (range) PHQ score decreased from 14.4 (13.1, 15.6) to 1.6 (0.8, 2.4) and 90% achieved depression remission, while mean maladaptive coping style scores decreased and mean adaptive coping scores and self-efficacy scores improved.
  
  
  CONCLUSIONS
  In this pilot study of an evidence-based depression treatment intervention for HIV-infected patients in Cameroon, a number of HIV behavioral and non-behavioral health outcomes improved over 4 months of effective depression treatment. These data are consistent with the hypothesis that better depression care can lead to improved HIV outcomes.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: University of Buea, Buea, Cameroon.
authors.forename: Julius
authors.initials: J
authors.lastname: Atashili
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
authors.forename: Julie K
authors.initials: JK
authors.lastname: O'Donnell
authors.affiliation: Department of Internal Medicine (Neurology Unit), the University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Njamnshi
authors.affiliation: HIV/AIDS Treatment Center, Bamenda Hospital, Bamenda, Cameroon.
authors.forename: Mbu Eyongetah
authors.initials: ME
authors.lastname: Tabenyang
authors.affiliation: Regional Technical Group for the fight against HIV North West region, Bamenda Hospital, Bamenda, Cameroon.
authors.forename: Charles Kefie
authors.initials: CK
authors.lastname: Arrey
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, United States of America.
authors.forename: Rachel
authors.initials: R
authors.lastname: Whetten
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, United States of America.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.affiliation: Department of Biomedical Sciences, University of Buea, Cameroon; Department of Microbiology and Immunology, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Peter
authors.initials: P
authors.lastname: Ndumbe
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002163:Cameroon; D003863:Depression / Q000188:drug therapy* / Q000209:etiology*; D055317:Evidence-Based Practice; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D044966:Anti-Retroviral Agents; D000928:Antidepressive Agents