Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial.
Background: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evid...
| Publicado en: | International Journal of Behavioral Medicine Vol. 30; no. 1; pp. 62 - 77 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Springer Nature
Feb2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=161516403&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 161516403 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10705503 7M2 jtl: International Journal of Behavioral Medicine issn: 10705503 maglogo: N pubinfo: dt: Feb2023 vid: 30 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 161516403 161516403 161516403 10.1007/s12529-022-10071-z 161516403 ppf: 62 ppct: 15 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial. aug: au: Psaros, Christina Stanton, Amelia M. Raggio, Greer A. Mosery, Nzwakie Goodman, Georgia R. Briggs, Elsa S. Williams, Marcel Bangsberg, David Smit, Jenni Safren, Steven A. affil: Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA sug: subj: Depression Therapy Pregnancy Complications, Psychiatric Therapy HIV Infections Transmission Disease Transmission, Vertical Prevention and Control HIV Infections Prevention and Control Perinatal Care Anti-Retroviral Agents Therapeutic Use HIV Infections Drug Therapy Pregnancy Complications, Infectious Drug Therapy Patient Compliance Evaluation Psychosocial Intervention Methods Treatment Outcomes Evaluation Human Randomized Controlled Trials Random Assignment Pregnancy Female Expectant Mothers Psychosocial Factors Adolescence Young Adult Adult Middle Age Pilot Studies Pretest-Posttest Design Infant, Newborn Descriptive Statistics Comparative Studies Confidence Intervals Support, Social Stigma Prevention and Control Qualitative Studies Self Concept Problem Solving Medication Compliance Evaluation Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Infant, Newborn: birth-1 month Female ab: Background: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. Method: Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. Results: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β = − 11.1, t(24) = − 3.1, p < 0.005, 95% CI [− 18.41, − 3.83], and 3 months, β = − 13.8, t(24) = − 3.3, p < 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. Conclusion: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. Trial Registration: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417 pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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