HIV treatment should address depression

By Lillian Namusoke Magezi

Researchers developed and evaluated a model for the integration of depression management into routine HIV care in Uganda

Policymakers in the health sector have been advised to add interventions for managing depression to the HIV care package.

The call was made by researchers at the Medical Research Council (MRC), Uganda Virus Research Institute (UVRI) and the London School of Health & Tropical Medicine LSHTM).

The recommendation came after a pilot study that was carried out in Mpigi showed that proposed interventions for treating depression among people living with HIV are highly feasible and acceptable by both the people living with HIV and the health workers. 

Prof. Eugene Kinyanda, the head of the mental health section for MRC, explained that they set out to do the pilot study after several studies that had been done in the past showed a high prevalence of depression among people living with HIV. Studies done in Masaka and Entebbe put the prevalence of depression among people living with HIV at an average of 14%, with Masaka having a prevalence of 19.5% and Entebbe having a prevalence of 8%.

Kinyanda added that generally speaking, the prevalence of depression among people living with HIV is estimated to be between 8% and 30%.

However, he decried the fact that most of the cases of depression among people living with HIV go undetected, and thus, untreated because of limited knowledge about depression among the communities and even the HIV health care service providers.

Because of the documented high prevalence of depression (and other forms of mental health conditions) among people living with HIV, the Uganda National HIV and AIDS Strategic Plan (2015-2020) calls for the integration of mental health into HIV care. In addition, in December 2016, the health ministry released consolidated guidelines for the prevention and treatment of HIV in Uganda in which it recommended the assessment and management of depression in people living with HIV.

In line with the above recommendations by the health ministry, the MRC in collaboration with UVRI and the London School of Health and Tropical Medicine set out to assess how feasible and acceptable it would be to add interventions to manage depression within the existing HIV care system in Uganda.

Under the project, researchers developed and evaluated a model for the integration of depression management into routine HIV care in Uganda. The model involved two treatment options for depression among people living with HIV, both of which seemed effective. These were treatment with medicine (antidepressants) and counselling.

About the study

Dr Leticia Kyohangirwe, a researcher attached to the mental health programme at MRC, explained that the aim of the pilot study was to develop and later evaluate at trial a depression management model for adult HIV care.

Dr Richard Mpango disclosed that the pilot study was carried out in a duration of six months in four public health care facilities in Mpigi district. The facilities were Nkozi Hospital, Mpigi HC IV, Butoolo HC III and Buwama HC III. Mpigi was chosen because the mental health unit of MRC only works within the central and southwestern Uganda and it was thought that Mpigi was easily accessible and convenient. In addition, they have also worked with Mpigi in the past, so there is some background information.

Kyohangirwe disclosed that a total of 131 people living with HIV and having signs of depression participated in the study; 35 were from Nkozi hospital, 35 from Mpigi HC IV, 31 from Butoolo HC III and 30 from Buwama HC III. The participants were given the freedom to choose what form of treatment they wanted (that is whether to be given medicine or to undergo counselling). According to Joshua Ssebunnya, a researcher with MRC, most of the participants chose to counsel because they did not want to add to their pill burden.

The participants were reviewed every month and data was collected, which showed a great improvement in their depressive symptoms with time.

Therefore, the researchers concluded that adding interventions for treating depression to HIV care is feasible and acceptable to both the health service providers and people living with HIV. Subsequently, based on the findings, the researchers recommended that all health workers be trained in offering to counsel.

Ssebunnya noted that the next step will be to subject the model to a trial in some districts to establish whether it can be adopted.