A feasibility study of behavioural activation therapy for HIV positive women
Lead Research Organisation:
University of Oxford
Department Name: UNLISTED
Abstract
Rates of HIV are very high amongst pregnant women in parts of sub-Saharan Africa (SSA) with, for example rates of over 30% in antenatal clinics in South Africa1. Many receive their diagnosis during pregnancy as partof screening to prevent mother-to-child transmission (PMTCT). Depression is very common amongst these women, with up to 40% screening above the threshold for depression2, 3. Perinatal depression is associatedwith poor adherence to antiretroviral treatment (ART)4, 5, low clinic attendance, suicidal ideation6 and lowrates of breastfeeding7. Of major concern is the evidence of negative effects on fetal outcomes, children'sgrowth and cognitive development7. Improving the wellbeing of mothers and infants requires effectivetreatment of HIV and perinatal depression8. Although treatment of depression improves adherence to HIVtreatment by >80% 5, there is no established effective treatment for perinatal depression in SSA for motherswith HIV. The aim of this study is to develop and test the feasibility and acceptability of a six-session intervention targeting perinatal depression in HIV-positive women. The intervention will utilise Behavioural Activation (BA), which has been shown to be as effective as Cognitive Behaviour Therapy (CBT) in high-income settings9. BA is much simpler than CBT to deliver, especially by non-specialist health workers withlimited training in under-resourced settings. This early phase study is needed to develop, standardise and pilot the BA intervention and test its feasibility. The study will provide treatment for 70 pregnant women and follow them to 3 months postnatally. The outcomes of the main study will include: maternal depression, child emotional and cognitive development and growth, adherence to ART, initiation and maintenance of breastfeeding, infant HIV testing and vaccinations. This work will be conducted at the Africa Centre for Health and Population Studies, a large demographic surveillance site in South Africa with a high HIV prevalence.
Technical Summary
Rates of HIV are very high amongst pregnant women in parts of sub-Saharan Africa (SSA) with, for example rates of over 30% in antenatal clinics in South Africa1. Many receive their diagnosis during pregnancy as partof screening to prevent mother-to-child transmission (PMTCT). Depression is very common amongst these women, with up to 40% screening above the threshold for depression2, 3. Perinatal depression is associatedwith poor adherence to antiretroviral treatment (ART)4, 5, low clinic attendance, suicidal ideation6 and lowrates of breastfeeding7. Of major concern is the evidence of negative effects on fetal outcomes, children'sgrowth and cognitive development7. Improving the wellbeing of mothers and infants requires effectivetreatment of HIV and perinatal depression8. Although treatment of depression improves adherence to HIVtreatment by >80% 5, there is no established effective treatment for perinatal depression in SSA for motherswith HIV. The aim of this study is to develop and test the feasibility and acceptability of a six-session intervention targeting perinatal depression in HIV-positive women. The intervention will utilise Behavioural Activation (BA), which has been shown to be as effective as Cognitive Behaviour Therapy (CBT) in high-income settings9. BA is much simpler than CBT to deliver, especially by non-specialist health workers withlimited training in under-resourced settings. This early phase study is needed to develop, standardise and pilot the BA intervention and test its feasibility. The study will provide treatment for 70 pregnant women and follow them to 3 months postnatally. The outcomes of the main study will include: maternal depression, child emotional and cognitive development and growth, adherence to ART, initiation and maintenance of breastfeeding, infant HIV testing and vaccinations. This work will be conducted at the Africa Centre for Health and Population Studies, a large demographic surveillance site in South Africa with a high HIV prevalence.
People |
ORCID iD |
Alan Stein (Principal Investigator) |
Publications
DeJong H
(2016)
Rumination and postnatal depression: A systematic review and a cognitive model.
in Behaviour research and therapy
Rochat TJ
(2018)
Psychological morbidity and parenting stress in mothers of primary school children by timing of acquisition of HIV infection: a longitudinal cohort study in rural South Africa.
in Journal of developmental origins of health and disease
Rochat T
(2017)
Parenting and HIV.
in Current opinion in psychology
Rochat TJ
(2017)
Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa.
in Social science & medicine (1982)
Description | These findings demonstrate both the feasibility and acceptability of the intervention as well as evidence for a striking reduction in depressive symptoms. This led to a full randomised control trial. |
First Year Of Impact | 2017 |
Sector | Healthcare |
Description | Research Grant, Joint Funded Initiatives Full |
Amount | £2,956,608 (GBP) |
Funding ID | MR/P006965/1 |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 04/2017 |
End | 03/2022 |
Description | Perinatal mental health project Cape Town UK |
Organisation | University of Cape Town |
Department | Department of Psychiatry and Mental Health |
Country | South Africa |
Sector | Academic/University |
PI Contribution | We worked with them to use their training materials to train health clinic staff around the recognition initial treatment and referral of mental health problems. |
Collaborator Contribution | We used their excellent perinatal mental health training materials. |
Impact | None |
Start Year | 2019 |
Description | MRC Insight Blog |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Alan Stein (PI) contributed a blog post to the MRC Insight blog setting the scene around perinatal depression in an HIV positive woman and explaining the combined therapy being tested. |
Year(s) Of Engagement Activity | 2017 |
URL | https://www.insight.mrc.ac.uk/2017/08/04/supporting-mothers-hiv-depression/ |
Description | Workshops |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | We conducted workshops to feed back on the findings of this study with local nurses. We also sought and received feedback on local barriers to identifying perinatal depression and recruiting into our larger study (RCT to evaluate an intervention for depressed HIV-positive women in the perinatal period, to enhance child development and reduce maternal depression). |
Year(s) Of Engagement Activity | 2017 |