Piloting a new model for diagnosing and treating depression in those living with HIV/AIDS in Lubombo

This study aims to develop an integrated approach to the diagnosis and treatment of depression among patients living with HIV and/or TB in the Lubombo Region of Eswatini. It is the first in the world to adapt and evaluate the use of a simple, evidence-based talking therapy called the Healthy Activity Program (HAP) for routine use in a healthcare system.
Depression is known to be commonly experienced by patients living with HIV and TB – both of which are relatively common conditions in the Kingdom of Eswatini. Patients suffering with depression are less likely to comply with treatment and other aspects of scheduled care. Similar to many other countries, Eswatini has a mental health ‘treatment gap’, with the demand for mental health services exceeding the capacity of the treatment system at present. Addressing this requires earlier identification and support for those with mild to moderate depression before they present in a state of crisis (e.g. following a suicide attempt).
There is good evidence for using simple, structured talking therapies to support these patients. Such an approach has the potential to be decentralised to the community level. The initial focus of this study will be on adult patients with HIV and/or TB who are known to be at increased risk of depression.

  • Develop an approach to screen and diagnose HIV/TB patients who are depressed
  • Adapt the HAP counselling approach for use in Eswatini and train nurses to deliver it to depressed patients under their care
  • Determine the acceptability and feasibility of HAP counselling
  • Make recommendations concerning the wider scale-up of depression screening and HAP counselling in Eswatini

The study involves:

  • Developing culturally-sensitive resources to support the screening, diagnosis and treatment of patients with depression
  • Designing and delivering training in mental health and HAP counselling to 16 nurses from the Lubombo Region
  • Screening HIV/TB patients at 7 sites in Lubombo to identify at-risk patients and measure the prevalence of depression in this group
  • Identifying at least 50 depressed patients who will be offered a course of HAP counselling
  • Collecting clinical data to determine the uptake and impact of HAP counselling
  • A qualitative study to further explore how depression manifests in Eswatini and the acceptability of HAP counselling to patients and nurses

Potential scaling up of research findings
The approach and resources are intended to be generalisable to other adult populations should the study recommend its wider use. If the intervention is considered feasible and acceptable to staff and patients, then the research group will work with stakeholders to address the:

  • procedures for depression screening within the healthcare system, including within chronic disease programmes
  • criteria/thresholds used to determine eligibility for HAP counselling (and other treatments) in Eswatini
  • identification of the most appropriate workforce to deliver HAP counselling
  • Resource implications of expanding HAP counselling
  • Review of referral pathways and linkages for depression within the health system

In-country partners

  • Ministry of Health
  • National Psychiatric Referral Hospital
  • Lubombo Regional Health Management Team
  • Good Shepherd Hospital
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