Kizito Wamala

After successfully developing and evaluating group support psychotherapy (GSP) as a first-line treatment for mild-to-moderate depression in adults, we aimed to adapt and assess this approach for children and adolescents (CA) (ages 10–18) living with HIV. In June 2021, 30 young people and 30 caregivers participated in separate GSP sessions. Data on psychosocial issues and GSP effectiveness were collected through focus groups and interviews. Insights were guided by the ecological validity and culturally sensitive framework. An open-label randomized controlled trial in Kitgum, with 120 participants, registered with PACTR, number 202006601935462, compared GSP plus intensive adherence counseling (IAC) to IAC alone, assessing feasibility, acceptability, depression, anxiety, and HIV treatment outcomes. We found that CA with HIV struggled with self-esteem issues, suicidal thoughts, medication adherence, and food insecurity, alongside stigma, discrimination, and limited mental health programs. The adult GSP model was adapted for CA by creating gender- and age-specific groups, simplifying language, and incorporating play and expressive art activities. Caregivers were concurrently engaged with the adult GSP model. GSP participants showed a significantly greater reduction in depression symptoms compared to IAC participants.

Objective: We aimed to determine the effect of group support psychotherapy (GSP) compared with group HIV education (GHE) on depression and HIV treatment outcomes 24 months after treatment. We further aimed to investigate the mediating role of depression and antiretroviral therapy (ART) adherence in the relationship between GSP and viral load suppression. Methods: Thirty HIV clinics across three districts were randomly assigned to deliver either GSP or GHE for depression. Depression and optimal (≥95%) ART adherence was assessed at baseline and 6, 12, 18, and 24 months after treatment. Viral load was drawn from the medical charts at baseline and 12 and 24 months after treatment. Multilevel mixed-effects regression models and generalized structural equation modeling were used to estimate 24-month outcomes and mediation effects. Results: Participants ( N = 1140) were enrolled from HIV clinics offering either GSP ( n = 578 [51%]) or GHE ( n = 562 [49%]). Fewer GSP than GHE participants met the criteria for depression at 24 months after treatment (1% versus 25%; adjusted odds ratio [aOR] = 0.002, 95% confidence interval [CI] = 0.0002–0.018). More GSP than GHE participants reported optimal (≥95%) ART adherence (96% versus 88%; aOR = 20.88, 95% CI = 5.78–75.33) and improved viral suppression (96% versus 88%; aOR = 3.38, 95% CI = 1.02–11.02). The indirect effects of GSP through sequential reduction in depression and improvement in ART adherence at 12 months may partially explain the higher viral suppression rates at 24 months in GSP than GHE groups. Conclusion: In settings where the HIV epidemic persists, depression treatment with GSP may be critical for optimal HIV treatment outcomes. Trial Registration: The Pan African Clinical Trials Registry, number PACTR201608001738234.

We describe the process evaluation for a randomized controlled trial that compared group support psychotherapy (GSP) with group HIV education for treatment of depression among people with HIV. Process data were obtained using mixed methods. Variables evaluated were indicators of feasibility and acceptability; causal mediating processes and contextual influences. GSP was feasible and acceptable. Potential mediating variables between GSP and reduction of depression were improved emotional and social support, better coping strategies, and pursuit of livelihoods. Culturally sensitive intervention content facilitated intervention delivery. These data complement the trial outcomes, and may provide a contextualized description of how GSP treats depression.