Effects of M-DEPTH Model of Depression Care on Maternal HIV Viral Suppression and Adherence to the PMTCT Care Continuum Among HIV-Infected Pregnant Women in Uganda: Results from a Cluster Randomized Controlled Trial at Pregnancy Completion

Springer Science and Business Media LLC - 2023
Glenn Wagner1, Violet Gwokyalya2, Laura J. Faherty1, Dickens Akena3, Janet Nakigudde3, Victoria K. Ngo4, Ryan McBain1, Bonnie Ghosh-Dastidar1, Jolly Beyeza-Kashesya5, Juliet Nakku6, Leticia Kyohangirwe6, Linda Nabitaka7, Hafsa Lukwata7, Barbara Mukasa8, Rhoda K. Wanyenze2
1RAND Corporation,1776 Main Street, Santa Monica, CA, 90407, USA
2Makerere University School of Public Health, Kampala, Uganda
3College of Health Sciences, Makerere University, Kampala, Uganda
4RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
5Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
6Butabika National Referral Mental Hospital, Kampala, Uganda
7Ministry of Health, Kampala, Uganda
8Mildmay Uganda, Kampala, Uganda

Tóm tắt

AbstractPerinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the prevention of mother-to-child transmission (PMTCT) care continuum; therefore, treating perinatal depression may result in increased viral suppression and PMTCT adherence. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on depression, maternal viral suppression and adherence to PMTCT care processes in an ongoing cluster-randomized controlled trial of 391 HIV-infected pregnant women (200 usual care; 191 intervention) with at least mild depressive symptoms enrolled across 8 antenatal care clinics in Uganda. At baseline, 68.3% had clinical depression and 41.7% had detectable HIV viral load. Adjusted repeated-measures multivariable regression models found that the intervention group was nearly 80% less likely to be clinically depressed [Adjusted OR (95% CI) 0.22 (0.05, 0.89)] at the 2-month post-pregnancy assessment, compared to the control group. However, the intervention and control groups did not differ meaningfully on maternal viral suppression, ART adherence, and other PMTCT care processes and outcomes. In this sample of women who were mostly virally suppressed and ART adherent at baseline, the depression care model had a strong effect on depression alleviation, but no downstream effects on viral suppression or other PMTCT care processes.Trial Registration NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).

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