Depression management and antiretroviral treatment outcome among people living with HIV in Northwest and East regions of Cameroon

Abstract

Background: Several interventions have shown benefits in improving mental health problems such as depression which is common in people living with HIV. However, there is a paucity of evidence on the effect of these interventions in improving HIV treatment outcomes. This study aimed at bridging this evidence gap and guiding the integration of depression and HIV management, particularly in rural health settings of Cameroon.

Materials and methods: We carried out a cluster-randomized intervention study targeting persons aged 13 years and above who had been on antiretroviral treatment for 6-9 months. Participants were followed up for 12 months during which those in the intervention group underwent routine screening and management of depression. Comparisons were done using the two-way ANOVA and Chi-squared test with significance set at 5%.

Results: Overall, 370 participants with a median age of 39 years (IQR: 30-49) were enrolled in this study. Of these, 42 (11.3%) were screened with moderate to severe depressive symptoms and 41 (11.1%) had poor treatment adherence. There was a significant drop in depression scores in the intervention group from 3.88 (± 3.76) to 2.29 (± 2.39) versus 4.35 (± 4.64) to 3.39 (± 3.0) in controls (p < 0.001) which was accompanied by a drop in the prevalence of moderate to severe depressive symptoms in the intervention group from 9% to 0.8% (p = 0.046). Decreased depression scores were correlated with better adherence scores with correlation coefficients of - 0.191, - 0.555, and - 0.513 at baseline, 6 months, and 12 months of follow-up respectively (p < 0.001) but there was no significant difference in adherence levels (p = 0.255) and viral suppression rates (p = 0.811) between groups.

Conclusion: The results of this study suggest that considering routine screening and management of depression as an integral component of HIV care could positively impact HIV treatment outcomes. However, there is a need for more research to identify the best combinations of context-specific and cost-effective strategies that can impactfully be integrated with HIV management. Trial registration Trial registration Number: DRKS00027440. Name of Registry: German Clinical Trials Register. Date registration: December 10, 2021 ('retrospectively registered'). Date of enrolment of the first participant: 05/08/2019.

Keywords: Adherence; Cameroon; Depression; HIV treatment outcomes; Interpersonal psychotherapy; Psychoeducation.

Fig. 1

Enrolment and follow up flowchart of study participants

Fig. 2

Effect of intervention on depression over time (left: all study participants, right: participants with depressive symptoms in study)

Fig. 3

Effect of intervention on treatment adherence over time (left: all study participants, right: participants with depressive symptoms in study)

Fig. 4

Effect of intervention on viral load suppression at 12 months of follow-up (A all study participants, B participants with depressive symptoms in study)