Parts of this manuscript were presented at the Out of the Shadows: Making Mental Health a Global Development Priority, World Bank and World Health Organisation high-level meeting which took place, April 13–14, 2016 in Washington, D.C.
Trial registration: The Pan African Clinical Trials Registry, numberPACTR201402000742370.
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.
Abas, M., Ali, G. C., Nakimuli-Mpungu, E., & Chibanda, D., 2014. Depression in people living with HIV in sub-Saharan Africa: Time to act. Tropical Medicine & International Health, 19(12), 1392–1396. CrossRef
Abasiubong, F., Ekott, J. U., Bassey, E. A., Etukumana, E. A., & Edyang-Ekpa, M. (2009). A controlled study of effect of counselling on psychological symptoms among people living with HIV/AIDS in Uyo Nigeria. Mary Slessor. Journal of Medicine, 9, 17–24.
Atekyereza, P. R. (2015). Deprivation, HIV and AIDS in northern Uganda. African Sociological Review/Revue Africaine de Sociologie, 18(1), 91–111.
Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Chesney, M., & Moss, A. (2001). Comparing objective measures of adherence to HIV antiretroviral therapy: Electronic medication monitors and unannounced pill counts. AIDS and Behavior, 5, 275–281. CrossRef
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press.
Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K. F., Neugebauer, R., Murray, L., & Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: A randomized controlled trial. The Journal of the American Medical Association, 298, 519–527. CrossRefPubMed
Brandler, S., & Roman, C. P. (2012). Group work: Skills and strategies for effective interventions. London: Routledge.
Braun, V.,& Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. CrossRef
Carney, D. (2003). Sustainable livelihoods approaches: Progress and possibilities for change. London: Department for International Development.
Chibanda, D., Cowan, F. M., Healy, J. L., Abas, M., & Lund, C. (2015). Psychological interventions for common mental disorders for people living with HIV in low-and middle-income countries: Systematic review. Tropical Medicine & International Health, 20(7), 830–839. CrossRef
Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., & Abas, M. A. (2011). Problem-solving therapy for depression and common mental disorders in Zimbabwe: Piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health, 11(1), 1. CrossRef
Hayes, R., & Moulton, L. (2009). Cluster randomised trials. Boca Raton: Chapman & Hall/CRC. CrossRef
Kaaya, S. F., Blander, J., Antelman, G., Cyprian, F., Emmons, K. M., Matsumoto, K., Chopyak, E., Levine, M., & Fawzi, M. C. S. (2013). Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status. AIDS Care, 25(7), 854–862. CrossRefPubMed
Linnan, L., & Steckler, A. (2002). Process evaluation for public health interventions and research. San Francisco, CA: Jossey-Bass.
Mental health innovation network repository of innovations. http://mhinnovation.net/sites/default/fi les/downloads/innovation/tools/The%20GSP%20manual_1st%20 Edition.pdf.19.
Nakimuli-Mpungu, E., Alderman, S., Kinyanda, E., Allden, K., Betancourt, T. S., Alderman, J. S., Alison, P., & Musisi, S. (2013). Implementation and scale-up of psycho-trauma centers in a post-conflict area: A case study of a private–public partnership in northern Uganda. PLoS Medicine, 10(4), e1001427. CrossRefPubMedPubMedCentral
Nakimuli-Mpungu, E., Mojtabai, R., Alexandre, P., Musisi, S., Katabira, E., Nachega, J. B., Treisman, G., & Bass, J. K. (2013a). Lifetime depressive disorders and adherence to anti-retroviral therapy in HIV-infected Ugandan adults: A case-control study. Journal of Affective Disorders, 145, 221–226. CrossRefPubMed
Nakimuli-Mpungu, E., Okello, J., Kinyanda, E., Alderman, S., Nakku, J., Alderman, J. S., Pavia, A., Adaku, A., Allden, K., & Musisi, S. (2013b). The impact of group counseling on depression, post-traumatic stress and function outcomes: A prospective comparison study in the Peter C. Alderman trauma clinics in northern Uganda. Journal of Affective Disorders, 151(1), 78–84. CrossRefPubMed
Nakimuli-Mpungu, E., Wamala, K., Okello, J., Alderman, S., Odokonyero, R., Mojtabai, R., Mills, E. J., Kanters, S., Nachega, J. B., & Musisi, S. (2015). Group support psychotherapy for depression treatment in people with HIV/AIDS in northern Uganda: A single-centre randomised controlled trial. The Lancet HIV, 2(5), e190–e199. CrossRefPubMed
Nakimuli-Mpungu, E., Wamala, K., Okello, J., Alderman, S., Odokonyero, R., Musisi, S., & Mojtabai, R. (2014a). Developing a culturally sensitive group support intervention for depression among HIV infected and non-infected Ugandan adults: A qualitative study. Journal of Affective Disorders, 163, 10–17. CrossRefPubMed
Nakimuli-Mpungu, E., Wamala, K., Okello, J., Alderman, S., Odokonyero, R., Musisi, S., Mojtabai, R., & Mills, E. J. (2014b). Outcomes, feasibility and acceptability of a group support psychotherapeutic intervention for depressed HIV affected Ugandan adults: A pilot study. Journal of Affective Disorders, 166, 144–150. CrossRefPubMed
Nyablade, L., & Mac Quarrie, K. (2006). Can we measure HIV/AIDS-related stigma and discrimination? Current knowledge about, quantifying stigma in developing countries. Policy Project. Washington, DC: International Center for Reasearch on Women (ICRW) and United States Agency for International Development(USAID). Retrieved from http://pdf.usaid.gov/pdf_docs/PNADF263.pdf.
Oakley, A., Strange, V., Bonell, C., Allen, E., & Stephenson, J. (2006). Process evaluation in randomised controlled trials of complex interventions. BMJ (Clinical Research Ed.), 332(7538), 413–416. CrossRef
Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., et al. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. Lancet, 376(9758), 2086–2095. CrossRefPubMedPubMedCentral
Petersen, I., Hancock, J. H., Bhana, A., & Govender, K. (2014). A group-based counseling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: A randomized controlled pilot study. Journal of affective disorders, 158, 78–84.
Pence, B. W., O’Donnell, J. K., & Gaynes, B. N. (2012). Falling through the cracks: The gaps between depression prevalence, diagnosis, treatment, and response in HIV care. AIDS (London, England), 26(5), 656–658. CrossRef
Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change (pp. 3–27). New York: Springer.
Purcell, D. W., Garfein, R. S., Latka, M. H., Thiede, H., Hudson, S., Bonner, S., & Ouellet, L. J. (2007). Development, description, and acceptability of a small-group, behavioral intervention to prevent HIV and hepatitis C virus infections among young adult injection drug users. Drug and Alcohol Dependence, 91, S73–S80. CrossRefPubMed
Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. Lancet, 372(9642), 902–909. CrossRefPubMedPubMedCentral
Sherr, L., Clucas, C., Harding, R., Sibley, E., & Catalan, J. (2011). HIV and depression—A systematic review of interventions. Psychology, Health & Medicine, 16, 493–527. CrossRef
Stein, E. R., & Smith, B. W. (2015). Social support attenuates the harmful effects of stress in healthy adult women. Social Science & Medicine, 146, 129–136. CrossRef
Tsai, A. C., Hatcher, A. M., Bukusi, E. A., Weke, E., Hufstedler, L. L., Dworkin, S. L., Kodish, S., Cohen, C. R., & Weiser, S. D. (2016). A livelihood intervention to reduce the stigma of HIV in rural Kenya: Longitudinal qualitative study. AIDS and Behavior, 21, 1–13.
- Process Evaluation of a Randomized Controlled Trial of Group Support Psychotherapy for Depression Treatment Among People with HIV/AIDS in Northern Uganda
Jean B. Nachega
Edward J. Mills
- Springer US