Effectiveness of Nurse-delivered Care for Adherence/Mood in HIV in South Africa

Effectiveness of Nurse-delivered Care for Adherence/Mood in HIV in South Africa

The purpose of this study is to conduct a two-arm effectiveness trial in Cape Town, South Africa of a Xhosa-adapted, nurse-delivered, cognitive behavioral therapy (CBT) treatment for depression and adherence, integrated into the HIV care setting in patients with HIV who did not achieve viral suppression from first-line treatment. The CBT treatment will be compared to enhanced usual care (Enhanced Treatment As Usual - ETAU) on study endpoints (as described in study endpoints section below).

Clinical Clinical depression is one of the highest comorbidities to HIV/AIDS, with estimated rates up to 34.9 percent. Depression, in the context of HIV, leads to poor self-care behavior such as non-adherence to ART and worse retention in care, which are critical for treatment success. Based on our prior work, and given that CBT is an evidenced-based treatment for depression, this is a two-arm effectiveness randomized controlled trial of nurse-delivered cognitive behavioral therapy for depression and adherence integrated into the HIV primary care setting in S. Africa. To ensure that those who need this intervention the most will receive it, participants will be patients with HIV who did not achieve viral suppression from their first line ART, and have a unipolar depressive mood disorder.

Inclusion Criteria:

• HIV-seropositive
• Current diagnosis of depression
• Did not attain viral suppression from first-line ARV per local clinic standard

Exclusion Criteria:

• Unable or unwilling to provide informed consent.
• Active untreated, major mental illness (untreated psychosis or mania) that would interfere with CBT-AD.
• Has not received CBT for depression.
• Less than 18 years of age.