Book Chapters

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12504/292

Browse

Browsing Book Chapters by Author "Kinyanda, Eugene"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Assessing the effectiveness of a depression-integrated model in adult HIV care in Uganda (the HIV+D trial) : a cluster-randomised controlled trial
    (The Lancet HIV, 2026-01-15) Kinyanda, Eugene; Kyohangirwe, Leticia; Mpango, Richard S; Sekitoleko, Isaac; Ssembajjwe, Wilber; Tusiime, Christine; Ssebunnya, Joshua; Katumba, Kenneth; Kiconco, Barbra Elsa; Laurence, Yoko; Tenya, Patrick; Turyahabwa, Joy; Katana, Patrick; Ross, Ian; Vassall, Anna; Giulia, Gre; Mugisha, James; Taasi, Geoffrey; Sentongo, Hafsa; Akena, Dickens; Muhwezi, Wilson W; Weiss, Helen A; Neuman, Melissa; Knizek, Birthe L; Levin, Jonathan; Kaleebu, Pontiano; Araya, Ricardo; Vikram, Patel
    Background Although depression is common in people with HIV, mental health interventions are not available to the vast majority of people with HIV in Africa. We aimed to test the effectiveness of the HIV+D collaborative stepped care depression intervention in adult HIV care in Uganda. Methods A cluster-randomised controlled trial was done at 40 randomly selected primary HIV care centres (clusters) at public health-care facilities in three districts in Uganda. The 40 clusters were randomly allocated (1:1) to enhanced usual care only (EUC arm) or to HIV+D intervention plus EUC, with the randomisation stratified by level of health facility. We recruited adults (aged 18 years or older) with HIV with depression, defined by the locally validated version of the Patient Health Questionnaire 9 (PHQ-9). Participants were consecutively recruited into the study clinics until there was a maximum of 30 participants per cluster. HIV+D was coordinated by a lay counsellor and involved four sequential steps of psychoeducation, behavioural activation, antidepressant medication, and referral. EUC comprised sharing screening results with the HIV clinic physician and training on the WHO guidelines for depression management in routine care. The primary outcome was PHQ-9 scores at 3 months. The trial is registered with the ISRCTN registry (ISRCTN86760765) and is completed. Findings 8441 people with HIV were referred to the trial, and 1115 (13%) were enrolled between May 3 and Dec 31, 2021. The mean age was 38 years, 859 (77%) were female, 535 were enrolled in the EUC group, and 580 were enrolled in the HIV+D plus EUC group. Primary outcome data were available for 1097 (98%) participants. We observed high levels of fidelity, with 290 (92%) of 316 participants in the HIV+D plus EUC intervention group receiving the recommended 4–10 sessions of behavioural activation. At 3 months, the mean PHQ-9 scores were lower in the HIV+D plus EUC group, at 3·0 (SD 3·2) compared with the EUC group, at 7·6 (SD 4·2; adjusted mean difference 4·4; 95% CI 3·4–5·5;p<0·0001; effect size [d]=1·34). This effect was sustained, although attenuated, at 12 months (adjusted mean difference 1·9; 95% CI 1·0–2·8; p<0·0001; d=0·81). Baseline depression severity scores moderated the HIV+D plus EUC intervention effect, with the intervention having stronger effects for those with baseline scores in the severe range (≥20) than for those whose scores were in the moderate range (10–19) both at 3 and 12 months (p values for effect modification were <0·001 and 0·005, respectively). There was no evidence of effect modification by sex nor baseline HIV viral load. One participant in the HIV+D plus EUC group was hospitalised because of severe depression.
  • Thumbnail Image
    Item
    A patchwork of good intentions: a critical look at different perspectives regarding ethics-based mental health care in under-resourced settings
    (Foundation of Ethics-Based Practices : Springer Nature, 2022-01-01) Knizek, Birthe Loa; Mugisha, James; Kinyanda, Eugene; Hjelmeland, Heidi
    Currently, there is an overall focus on mental health as a global health priority in the United Nations (Sustainable developmental Goals), World Health Organization (WHO), and Global Mental Health (movement and study field). As “mental disorder” is constructed as universal, the consequence is that the focus is on the treatment gap as a result of the huge inequalities regarding access to mental health care and treatment (Mills and Fernando, Disability and the Global South 1:188–202, 2014). UN’s Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (UN Human Rights Council, https://reliefweb.int/sites/reliefweb.int/files/resources/G1707604.pdf, 2017) urges the promotion of mental health for all ages in all settings as a general human right. In the historical basis for Global Mental Health, we find efforts to improve mental health for people living in under-resourced settings. According to mainstream, this means that the Global South should get better access to staff trained after standards and evidence-based treatment from the Global North. Critics rebut this approach since evidence-based practices developed in a Western setting transferred to different contexts might have unethical consequences, due to the ruling idea of a universal human, by pathologizing individuals rather than their sociopolitical-economic conditions. Attempts have been made to bypass or solve the discussion on the possibility of combining culture and the notion of a universal human which is implicit in Western evidence-based practice. Human rights and ethics-based practices are the ideals of all approaches, but all seem to have unforeseen consequences that go against these ideals. In this chapter, we take a critical look at different perspectives and the debate around ethics-based practice in mental health care in under-resourced settings.