Systematic Review of Interventions for Depression for People Living with HIV in Africa

Abstract

Background. Interventions for depression among those with HIV/AIDS in Africa are being evaluated in increasing numbers. However, feasibility, acceptability, and effectiveness have yet to be reviewed. We aimed to evaluate depression interventions performed in Africa for HIV infected adults. Methods. Using key terms: depression, Africa, and HIV, we searched MEDLINE to identify depression interventions for adults with HIV in Africa. Women in the perinatal period were excluded. Data were extracted and the weighted relative change in depression scores for interventions and net efect over controls calculated. Results. Data were obtained from 18 articles (n = 1956 HIV-infected participants). Of those, 1358 received interventions and 558 were controls. Six of seven studies evaluating feasibility were positive vs. seven positive studies evaluating acceptability. Tree studies investigated the use of psychotherapy (73% intervention decrease, 39% net decrease). Four studies investigated task-shifing of psychotherapy (47% intervention decrease, 34% net decrease). Tree studies investigated antidepressants (79% intervention decrease, 39% net decrease). Tree studies investigated task-shif-ing of antidepressant treatment (82% intervention decrease, 65% net decrease). An exercise intervention was evaluated (66% intervention decrease, 49% net decrease). One randomized trial investigated minocycline with insignificant results. Finally, three studies investigated other psychosocial interventions (44% intervention decrease, 21% net decrease). Conclusion. Evaluation of 18 articles showed multiple interventions had high feasibility and acceptability for depression care in people with depression and HIV in Africa. Larger randomized, controlled trials are needed to prove effcacy in this population as well as implementation trials to evaluate how best to improve depression care in resource-poor settings. [Figure Presented].