Changes in HIV Outcomes Following Depression Care in a Resource-Limited Setting: Results from a Pilot Study in Bamenda, Cameroon

Little is known about how improved depression care affects HIV-related outcomes in Africa. In a sample of depressed HIV patients in a low income, sub-Saharan country, we explored how implementing measurement-based antidepressant care (MBC) affected HIV outcomes over 4 months of antidepressant treatment.

As part of a project adapting MBC for use in Cameroon, we enrolled 41 depressed HIV patients on antiretroviral therapy in a pilot study in which a depression care manager (DCM) provided an outpatient HIV clinician with evidence-based decision support for antidepressant treatment. Acute depression management was provided for the first 12 weeks, with DCM contact every 2 weeks and HIV clinician appointments every 4 weeks. We measured HIV clinical and psychiatric outcomes at 4 months.

Participants were moderately depressed at baseline (mean Patient Health Questionnaire [PHQ] score = 14.4, range 13.1, 15.6). All HIV clinical outcomes improved by four month follow-up: mean (range) CD4 count improved from 436 (2, 860) to 452 (132, 876), mean (range) log-viral load decreased from 4.02 (3.86, 4.17) to 3.15 (2.81, 3.49), the proportion with virologic suppression improved from 0% to 18%, mean (range) HIV symptoms decreased from 6.4 (5.5, 7.3) to 3.1 (2.5, 3.7), the proportion reporting good or excellent health improved from 18% to 70%, and the proportion reporting any missed ARV doses in the past month decreased from 73% to 55%. Concurrently, psychiatric measures improved. The mean (range) PHQ score decreased from 14.4 (13.1, 15.6) to 1.6 (0.8, 2.4) and 90% achieved depression remission, while mean maladaptive coping style scores decreased and mean adaptive coping scores and self-efficacy scores improved.

In this pilot study of an evidence-based depression treatment intervention for HIV-infected patients in Cameroon, a number of HIV behavioral and non-behavioral health outcomes improved over 4 months of effective depression treatment. These data are consistent with the hypothesis that better depression care can lead to improved HIV outcomes.

Full article at: http://goo.gl/0JHBKy

By:

Bradley N. Gaynes

Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America

Brian W. Pence, Julie K. O’Donnell

Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America

Julius Atashili

University of Buea, Buea, Cameroon

Alfred K. Njamnshi

Department of Internal Medicine (Neurology Unit), the University of Yaoundé I, Yaoundé, Cameroon

Mbu Eyongetah Tabenyang

HIV/AIDS Treatment Center, Bamenda Hospital, Bamenda, Cameroon

Charles Kefie Arrey

Regional Technical Group for the fight against HIV North West region, Bamenda Hospital, Bamenda, Cameroon

Rachel Whetten, Kathryn Whetten

Duke Global Health Institute, Duke University, Durham, NC, United States of America

Peter Ndumbe

Department of Biomedical Sciences, University of Buea, Cameroon

Peter Ndumbe

Department of Microbiology and Immunology, University of Yaoundé I, Yaoundé, Cameroon

  

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