title: 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.
abstract: 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.
authors.affiliation: Health Service & Population Research Department, Centre for Public Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO 60, De Crespigny Park, London, SE5 8AF, UK. melanie.abas@kcl.ac.uk.
authors.forename: Melanie
authors.identifier: 0000-0003-1716-5584
authors.initials: M
authors.lastname: Abas
authors.affiliation: College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Primrose
authors.initials: P
authors.lastname: Nyamayaro
authors.affiliation: Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Tarisai
authors.initials: T
authors.lastname: Bere
authors.affiliation: College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Emily
authors.initials: E
authors.lastname: Saruchera
authors.affiliation: Parirenyatwa General Hospital, Harare, Zimbabwe.
authors.forename: Nomvuyo
authors.initials: N
authors.lastname: Mothobi
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.affiliation: College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Walter
authors.initials: W
authors.lastname: Mangezi
authors.affiliation: Health Service & Population Research Department, Centre for Public Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO 60, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Macpherson
authors.affiliation: Health Service & Population Research Department, Centre for Public Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO 60, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Croome
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Magidson
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Azure
authors.initials: A
authors.lastname: Makadzange
authors.affiliation: Department of Psychology, University of Miami, Miami, FL, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Safren
authors.affiliation: College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.|Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Dixon
authors.initials: D
authors.lastname: Chibanda
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology* / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology* / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010561:Personnel Staffing and Scheduling; D011340:Problem Solving; D015397:Program Evaluation; D015030:Zimbabwe / Q000453:epidemiology
keywords: Adherence; Depression; Intervention; Problem solving; Sub-Saharan Africa