Browsing by Author "Kyohangirwe, Leticia"

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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.
Effectiveness and cost-effectiveness of integrating the management of depression into routine HIV care in Uganda (the HIV + D trial) : a protocol for a cluster-randomised trial
(Springer Nature: International Journal of Mental Health Systems, 2021-05-12) Kinyanda, Eugene; Kyohangirwe, Leticia; Mpango, Richard S.; Tusiime, Christine; Ssebunnya, Joshua; Katumba, Kenneth; Tenywa, Patrick; Mugisha, James; Taasi, Geoffrey; Sentongo, Hafsa; Akena, Dickens; Laurence, Yoko; Muhwezi, Wilson; Weiss, Helen A.; Neuman, Melissa; Greco, Giulia; Knizek, Birthe; Levin, Jonathan; Kaleebu, Pontiano; Araya, Ricardo; Ssembajjwe, Wilber; Patel, Vikram
An estimated 8-30% of people living with HIV (PLWH) have depressive disorders (DD) in sub- Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD among PLWH, but no evidence on how these can be integrated into routine HIV care. This protocol describes a cluster-randomised trial to evaluate the effectiveness and cost-effectiveness of the HIV+D model for the integration of a collaborative stepped care intervention for DD into routine HIV care, which we have developed and piloted in Uganda. Methods: Forty public health care facilities that provide HIV care in Kalungu, Masaka and Wakiso Districts will be randomly selected to participate in the trial. Each facility will recruit 10-30 eligible PLWH with DD and the total sample size will be 1200. The clusters will be randomised 1:1 to receive Enhanced Usual Care alone (EUC, i.e. HIV clinicians trained in Mental Health Gap Action Programme including guidelines on when and where to refer patients for psychiatric care) or EUC plus HIV+D (psychoeducation, Behavioural Activation, antidepressant medication and referral to a supervising mental health worker, delivered in a collaborative care stepwise approach). Eligibility criteria are PLWH attending the clinic, aged >18 years who screen positive on a depression screening questionnaire (Patient Health Questionnaire, PHQ-9≥10). The primary outcome is the mean depressive disorder symptom severity scores (assessed using the PHQ-9) at 3 months post-randomisation, with secondary mental health, disability, HIV and economic outcomes measured at 3 and 12 months. The cost-effectiveness of EUC with HIV+D will be assessed from both the health system and the societal perspectives by collecting health system, patient and productivity costs and mean DD severity scores at 3 months, additional to health and non-health related quality of life measures (EQ-5D-5L and OxCAP-MH). Discussion: The study 􀂦ndings will inform policy makers and practitioners on the cost-effectiveness of a stepped care approach to integrate depression management in routine care for PLWH in low resource settings.