London School of Hygiene & Tropical Medicine

“Depressive disorders have negative effects, such as severe psychological distress, rapid HIV disease progression, poor adherence to antiretroviral therapy, risky sexual behaviour, and increased utilization of health services. Despite this burden, there are no mental health services in HIV care across most of sub-Saharan Africa,” says Professor Eugene Kinyanda, Principal Investigator, HIV+D study. 

With support from Wellcome Trust, the ‘Integrating the management of depression into routine HIV care in Uganda – The HIV+D Trial’, a 6-year study aimed at developing and testing the effectiveness of a depression integration model for adult HIV in Uganda that addresses implementation barriers convened a closing event to disseminate results to key stakeholders. The study, a partnership between the Unit and the Uganda Ministry of Health brought together key stakeholders from the health, research and academic fraternities, government and persons living with HIV to discuss and understand the dynamics of depression management in Uganda’s HIV patient care system.  

The introduction of a mental health education component into patient management services in waiting areas of HIV clinics at selected health facilities during the pilot study facilitated the recruitment, training, and supervision of lay health workers in the screening and delivery of psychotherapy services to persons living with HIV using the ‘brief trans-diagnostic psychotherapy of behavioural activation’. The therapy is known for its effectiveness against depression, anxiety, and improved ART adherence.   

The methodology determined the effectiveness of consistent integrated mental health support for persons living with HIV at improving antiretroviral therapy adherence and managing depression and anxiety disorders among those attending care at public health care facilities. The method was also found to be a cost-effective measure in holistic health service delivery, being able to address patient care challenges and increase mental health literacy among health professionals at the same time. 

“I learnt that depression is prevalent among people living with HIV, although it is often not recognized at primary health facilities,” Ms Betty Ndagire, a counsellor who participated in the pilot study, highlighted.  

Key stakeholders at the event committed to develop interventions aimed at establishing an inclusive multi-stakeholder approach to addressing gaps in the integration of mental health support into HIV care systems country-wide, such as low literacy about mental health and insufficient professional staffing at health facilities.  

On behalf of the Director of Mental Health at the Uganda Ministry of Health, Dr Faith Nakiyimba, the District Health Officer of Masaka urged health workers to be more vigilant and dedicated to the use of proper mental health support tools while providing health care services to persons living with HIV. She said,   

“I urge all health workers to diligently continue conducting patient assessments for effective HIV treatment, and to commit to work together towards our national target of combating HIV by 2030.” 

About the Project

The HIV+D mental health intervention model is a stepped care collaborative model based on the brief psychotherapy of Behavioural Activation that is delivered by trained and supervised lay health workers supported by HIV clinical counsellors and HIV clinicians. The formative work of developing the HIV+D mental health intervention model was undertaken in Mpigi district. The cluster randomised trial to assess the effectiveness and cost-effectiveness of the developed HIV+D Trial was undertaken in 40 public health care facilities in the districts of Wakiso, Masaka and Kalungu.  

About the NCD Theme 

The NCD Research Theme seeks to study and understand the distinct manifestations of chronic illnesses such as diabetes, cardiovascular diseases and mental illness in sub-Saharan Africa, and their drivers, as well as develop appropriate prevention and management intervention strategies.

Learn more about the NCD research theme