Healthy Options: Group Psychotherapy for HIV-positive Depressed Perinatal Women.
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      Although there is a significant burden of depression among HIV-positive women in Tanzania,
      there is a critical gap between the needs of this population and the integration of mental
      health and PMTCT-plus services. The long-term intent of the research is to bridge this gap
      with the overall goal to examine the potential for successful integration of enhanced mental
      health care and brief group interventions among HIV-positive women receiving PMTCT-plus
      services and to evaluate a combination of evidence-based approaches for treatment of
      depression in this vulnerable population in Tanzania.
    

Detailed description: 
      In resource-limited settings, there has been a significant increase in access to
      antiretroviral therapy (ART) in recent years. Although there remain serious limitations in
      access to ART in these settings, for many who have initiated and continue treatment, HIV
      disease is a chronic condition that needs to be managed over time. There is considerable
      evidence that individuals with chronic illness have an increased risk of depression, in part
      related to the challenges in coping and managing their illness. Rates for depression during
      pregnancy in women living with HIV are estimated to be higher.

      Despite this relatively high burden of depression among persons living with HIV/AIDS (PLHA),
      it has been documented that clinical staff working with PLHA do not routinely identify or
      treat depression in this setting. This is in contrast to recent revisions in the Tanzanian
      health policy that emphasize integrating mental health and HIV care at district and lower
      level health care services. The long-term intent of the research is to bridge this gap
      between Tanzanian health policy and implementation of integrating mental health care among
      pre- and post-natal women receiving HIV care. Therefore, the overall goal of the proposed
      study is to examine the potential for successful integration of enhanced mental health care
      and group counseling among HIV-positive women receiving preventing mother to child
      transmission (PMTCT)-plus services and to evaluate a combination of evidence-based approaches
      in treatment of depression in this vulnerable population in Tanzania.

      Specifically this application aims to:

        1. Examine the acceptability and feasibility of integrating an enhanced standard of mental
           health care and group counseling with PMTCT-plus services provided at government-run
           maternal and child health (MCH) clinics, from the perspectives of: a) facility mental
           health care focal points and MCH clinic managers, b) perinatal direct care providers;
           and c) HIV-positive perinatal women;

        2. Validate a depression screening tool for major depressive disorder (MDD) and suicidality
           for use in Tanzania; and

        3. Conduct a cluster randomized controlled trial comparing a task-sharing approach (i.e.
           problem solving and cognitive behavioral therapy components delivered to groups
           facilitated by lay community based health care workers (CBHWs) versus improved standard
    

Intervention name(s): Task-sharing approach to group therapy; Enhanced standard of care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will also identify, select and clarify common concerns/problems; provide orientation to steps in problem-solving; break down identified problems into manageable pieces; choose pieces of problem to address in facilitated discussion of problem solving for implementing solutions; support the sharing of feedback of strategies used in problem-solving and maintaining pleasurable activities.
Additionally, the intervention to aim to effect behavior by: explaining the links between problems, negative thoughts, choices made on a day-to-day basis, behaviors, and mood (symptoms of depression); facilitate sharing of practical skills to tackle problems, to change mood-related thoughts, choices and/or behaviors; offer and provide feedback on homework assignments to encourage practice of skills; and help participants attribute reported improvements to the use of new skills during feedback sessions.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: HIV; AIDS; Tanzania; depression; perinatal; psychotherapy; task-sharing; problem-solving