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

Depression worsens outcomes for people with HIV at every level of the HIV care cascade. Individuals with HIV and depression are less likely to engage in care, be retained in care, and even have higher mortality. The connection between depression and worse HIV outcomes is true globally, although the burden of HIV is highest in Africa. Depression interventions for individuals with HIV/AIDS in Africa are being increasingly evaluated. In 2018 I completed a systematic review. MEDLINE was searched using key terms: depression, Africa, and HIV, to identify depression interventions for HIV-infected adults in Africa. Perinatal women were excluded. Results were extracted, and relative change in depression scores for interventions and net effect were calculated. The MEDLINE search yielded 18 articles.
Six of seven studies evaluating feasibility were positive, and seven studies evaluating acceptability were also positive. Three studies investigated the effect of psychotherapy (% relative decrease of depressive symptoms for intervention: %net decrease compared to controls) (73%:39% decrease). Four studies investigated task-shifting of psychotherapy (47%:34% decrease). Three studies evaluated antidepressants (79%:39% decrease). Three studies investigated task-shifting of antidepressant treatment (82%:65% decrease). An exercise intervention was evaluated (66%:49% decrease). One trial investigated minocycline with non-statistically significant results. Finally, three studies investigated other psychosocial interventions (44%:21% decrease). Overall, our results highlighted the need for large, randomized trials to establish efficacy and implementation studies. Since 2018 a group in South Africa has published a pilot study and randomized controlled trial evaluating task shifted cognitive behavioral therapy with promising results. A group in Kenya did similar work using interpersonal psychotherapy in women, also with good results. Other similar studies are underway, including my group’s evaluation of group therapy in Uganda. Overall there is exciting work evaluating depression interventions for Africans with HIV, which is greatly needed given the burdens of disease in this population.