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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Feasibility, safety, acceptability, and preliminary efficacy of measurement-based care depression treatment for HIV patients in bamenda, cameroon
AIDS and Behavior, Volume 18, No. 6, Year 2014
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Description
Depression affects 18-30 % of HIV-infected patients in Africa and is associated with greater stigma, lower antiretroviral adherence, and faster disease progression. However, the region's health system capacity to effectively identify and treat depression is limited. Taskshifting models may help address this large mental health treatment gap. Measurement-Based Care (MBC) is a taskshifting model in which a Depression Care Manager guides a non-psychiatric (e.g., HIV) provider in prescribing and managing antidepressant treatment. We adapted MBC for depressed HIV-infected patients in Cameroon and completed a pilot study to assess feasibility, safety, acceptability, and preliminary efficacy. We enrolled 55 participants; all started amitriptyline 25-50 mg daily at baseline. By 12 weeks, most remained at 50 mg daily (range 25-125 mg). Median (interquartile range) PHQ-9 depressive severity scores declined from 13 (12-16) (baseline) to 2 (0-3) (week 12); 87 %achieved depression remission (PHQ-9 < 5) by 12 weeks. Intervention fidelity was high: HIV providers followed MBC recommendations at 96 % of encounters. Most divergences reflected a failure to increase dose when indicated. No serious and few bothersome side effects were reported. Most suicidality (prevalence 62 % at baseline; 8 % at 12 weeks) was either passive or low-risk. Participant satisfaction was high (100 %), and most participants (89 %) indicated willingness to pay for medications if MBC were implemented in routine care. The adapted MBC intervention demonstrated high feasibility, safety, acceptability, and preliminary efficacy in this uncontrolled pilot study. Further research should assess whether MBC could improve adherence and HIV outcomes in this setting. © Springer Science+Business Media New York 2014.
Authors & Co-Authors
Pence, Brian Wells
United States, Chapel Hill
The University of North Carolina at Chapel Hill
United States, Durham
Duke University
Gaynes, Bradley N.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Atashili, Julius
Cameroon, Buea
University of Buea
O'Donnell, Julie K.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Kats, Dmitry
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Whetten, Kathryn D.
United States, Durham
Duke University
Njamnshi, Alfred Kongnyu
Cameroon, Yaounde
Université de Yaoundé I
Mbu, Tabenyang
Cameroon
Bamenda Hospital
Kefie, Charles
Cameroon
Bamenda Hospital
Asanji, Shantal
Cameroon
Bamenda Hospital
Ndumbe, Peter Martins
Cameroon, Buea
University of Buea
Cameroon, Yaounde
Université de Yaoundé I
Statistics
Citations: 41
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1007/s10461-014-0727-x
ISSN:
10907165
e-ISSN:
15733254
Research Areas
Health System And Policy
Infectious Diseases
Mental Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Cameroon