Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa

Melanie Abas, Primrose Nyamayaro, Tarisai Bere, Emily Saruchera, Nomvuyo Mothobi, Victoria Simms, Walter Mangezi, Kirsty Macpherson, Natasha Croome, Jessica Magidson, Azure Makadzange, Steven Safren, Dixon Chibanda, Conall O’Cleirigh

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire—4.7 points in PST-AD arm vs. control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.

Original languageEnglish (US)
Pages (from-to)86-101
Number of pages16
JournalAIDS and Behavior
Volume22
Issue number1
DOIs
StatePublished - Jan 1 2018

Keywords

  • Adherence
  • Depression
  • Intervention
  • Problem solving
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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    Abas, M., Nyamayaro, P., Bere, T., Saruchera, E., Mothobi, N., Simms, V., Mangezi, W., Macpherson, K., Croome, N., Magidson, J., Makadzange, A., Safren, S., Chibanda, D., & O’Cleirigh, C. (2018). Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa. AIDS and Behavior, 22(1), 86-101. https://doi.org/10.1007/s10461-016-1659-4