Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial.

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY Journal of affective disorders Pub Date : 2024-10-21 DOI:10.1016/j.jad.2024.10.061

Babalwa Zani, Lara Fairall, Inge Petersen, Naomi Folb, Arvin Bhana, Jill Hanass-Hancock, One Selohilwe, Ruwayda Petrus, Daniella Georgeu-Pepper, Ntokozo Mntambo, Tasneem Kathree, Sergio Carmona, Carl Lombard, Crick Lund, Naomi Levitt, Max Bachmann, Graham Thornicroft

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Abstract

Background: HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities.

Methods: We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL).

Results: The intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = -0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = -0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study.

Limitations: The highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low.

Conclusion: The trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services.

Trial registration: ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).

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南非初级医疗机构采用任务分担协作护理模式检测和管理接受抗逆转录病毒疗法的成人抑郁症的效果：实用分组随机对照试验。

背景：艾滋病患者合并抑郁症等精神疾病的比例很高，因此，检测和治疗合并抑郁症对于实现病毒载量抑制至关重要。本研究评估了在初级卫生保健（PHC）机构接受抗逆转录病毒疗法的合并抑郁症状的成人中，抑郁症合作护理干预的有效性：我们在南非西北省的 40 家诊所开展了一项务实的分组随机试验。初级卫生保健诊所按分区进行分层，并以 1:1 的比例进行随机分配。参与者年龄≥18岁，正在接受抗逆转录病毒疗法，患者健康问卷-9（PHQ-9）得分≥9分，显示有抑郁症状。干预诊所接受了：i）针对初级保健中心护士的补充心理健康培训和临床沟通技巧；ii）针对初级保健中心医生的抑郁症治疗研讨会；iii）非专业咨询服务。通过混合效应回归模型，我们评估了 6 个月时 PHQ-9 反应（PHQ-9 基线得分降低≥50%）和 12 个月时病毒载量抑制（病毒载量）的共同主要结果：干预对 PHQ-9 反应（49% vs 57%，风险差异 (RD) = -0.08，95% CI = -0.19；0.03，p = 0.184）或病毒载量抑制（85% vs 84%，RD = 0.02，95% CI = -0.01；0.04，p = 0.125）没有影响。护士将 4298 名门诊患者转介给了咨询师，但在研究过程中，只有 66/1008 (7 %) 的干预组参与者在任何时候转介给了咨询师：局限性：该试验采用的高度务实的方法限制了干预措施中咨询部分的接触，转介给医生开始抗抑郁治疗的比例极低：该试验表明，以地区为基础的干预措施对加强抑郁症的合作治疗没有效果。该试验揭示了在加强心理健康服务方面存在的治疗差距：试验注册：ClinicalTrials.gov（NCT02407691）；泛非临床试验注册（201504001078347）。

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.