Task Shifting and Delivery of Behavioral Medicine Interventions in Resource-Poor Global Settings: HIV/AIDS Treatment in sub-Saharan Africa

Abstract

In this chapter, we aim to demonstrate how the use of task shifting for delivering biomedical HIV care in sub-Saharan Africa can inform efforts to use task shifting models to deliver behavioral medicine interventions for individuals living with HIV/ AIDS in this setting. In doing so, we first describe the widespread HIV/AIDS epidemic in sub-Saharan Africa and the shortage of trained health care providers to meet the needs of the epidemic. We describe task shifting efforts for expanding access to HIV medication in sub-Saharan Africa, and then illustrate how this approach to task shifting can be used to inform a similar approach for evidence-based behavioral medicine interventions among individuals living with HIV/AIDS in sub-Saharan Africa. We move from a broad overview of task shifting in HIV care in sub-Saharan Africa to specific examples of task shifting efforts to deliver evidence-based cognitive behavioral therapy (CBT) among individuals living with HiV/AIDS in sub-Saharan Africa. These efforts to task shift CBT address HIV medication adherence and commonly co-occurring psychological symptoms that interfere with successful HIV/ AIDS outcomes, including depression and substance use. Although at the time of writing there have been few examples of task shifting of CBT to address psychosocial and behavioral medicine issues among individuals living with HIV/AIDS in in sub- Saharan Africa, there have been a few promising early examples, including in the treatment of depression in Zimbabwe, the treatment of alcohol use in Kenya, and integrated interventions for depression and HIV medication adherence in South Africa. From these in-depth examples of task shifting CBT for alcohol use, depression, and integrated adherence interventions, we discuss considerations when adapting and implementing CBT using a task shifting model in this population. Finally, we discuss future directions and novel methodologies, for instance using multimedia-based interventions to promote standardization of task shifting delivery of CBT interventions and/or facilitate the use of these techniques by live interventionists. We also discuss the need to move from efficacy and effectiveness designs to more implementation science focused methods to promote sustainable integration of CBT for behavioral medicine in HIV care in sub-Saharan Africa. (PsycInfo Database Record (c) 2025 APA, all rights reserved) (Source: chapter)