Impact of depression and other common mental disorders on antiretroviral treatment outcomes among Malawian women in the PEPFAR-promote study

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Kamuzu University of Health Sciences
Common mental disorders (CMDs) are highly prevalent among people living with HIV(PLWHIV). If left untreated, they negatively affect HIV treatment outcomes. Low cost, low intensity interventions for CMDs such as Friendship Bench problem solving therapy (FB-PST) are being adopted in various clinical care settings. There is need to test effectiveness of these interventions in randomized controlled trials. The objectives of this study was to determine the prevalence of Common Mental Disorders (CMDs) among Women living with HIV (WLHIV) on lifelong antiretroviral therapy (ART) and efficacy of Friendship Bench Problem Solving Therapy (FB-PST) on CMD symptoms and viral load (a composite marker of ART adherence). A randomized FB-PST intervention among WLHIV at the Blantyre, Malawi site co-enrolled in the multi-country PEPFAR PROMOTE cohort study was conducted, with 18 months follow-up for HIV-ART outcomes. Standardized Self Reporting Questionnaire (SRQ)-20 was used to screen for CMDs (March 2018- Dec 2018). Eligible women with a CMD without suicidality were randomized to receive FB-PST (trained study peer-counselors) or referred for standard-of-care (SOC) treatment. Prevalence of SRQ-20 based CMD was high, 65/326 (19.9%); of these, 52 eligible women were randomized to FB-PST or SOC (1:1 ratio). Pre-intervention, 48 (90.6%) participants diagnosed with CMD had VL<1000 copies/ml and 160 (89.4%) without CMD had VL<1000 copies/ml (p=0.804). 14(21.5%) CMD sufferers reported suicidality. At 6 months postintervention, 26(100%) FB-PST treated women had VL <1000 copies/ml versus 18(69.2%) women in SOC arm (p= 0.005). At 12 months post-intervention, 26(100%) in the FB-PST arm maintained VL <1000 copies/ml versus vii 18(69.2%) in the SOC-treated arm. 18 months post-intervention, 18 (69.2%) women in the FB-PST arm had VL<1000copies/ml compared to 8 (30.7%) in the SOC arm (p=0.062). 14 (53.8%) treated with FB-PST had CMD resolution (SRQ score <8) 6 months post- intervention versus 16 (61.5%) in the SOC arm (p=0.804). In conclusion, there was high prevalence of CMDs among WLHIV. Task shifting models of CMD treatment such as Friendship Bench PST are potentially as effective as standard of care in improving CMD symptoms and HIV treatment outcomes if they are delivered in their entirety as intended.