The Effect of Group Support Psychotherapy Delivered by Trained Lay Health Workers for Depression Treatment Among People with HIV in Uganda: Protocol of a Pragmatic, Cluster Randomized Trial

Etheldreda Nakimuli-Mpungu; Seggane Musisi; Kizito Wamala; James Okello; Sheila Ndyanabangi; Ramin Mojtabai; Jean Nachega; Ofir Harari; Edward Mills

doi:10.2196/resprot.8925

The Effect of Group Support Psychotherapy Delivered by Trained Lay Health Workers for Depression Treatment Among People with HIV in Uganda: Protocol of a Pragmatic, Cluster Randomized Trial

JMIR Res Protoc. 2017 Dec 11;6(12):e250. doi: 10.2196/resprot.8925.

Authors

Etheldreda Nakimuli-Mpungu^#¹, Seggane Musisi^#¹, Kizito Wamala^#², James Okello^#³, Sheila Ndyanabangi^#⁴, Ramin Mojtabai^#⁵, Jean Nachega^#^{6

7

8

9}, Ofir Harari^#¹⁰, Edward Mills^#¹¹

Affiliations

¹ Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
² Department of Psychology, Center for Victims of Torture, Gulu, Uganda.
³ Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda.
⁴ Mental Health Program, Ministry of Health of Uganda, Kampala, Uganda.
⁵ Department of Mental Health, Bloomberg's School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
⁶ Department of Epidemiology, Pittsburg Graduate School of Public Health, University of Pittsburg, Pittsburgh, PA, United States.
⁷ Stellenbosch Center for Infectious Disease, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
⁸ Department of Epidemiology, Bloomberg's School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
⁹ Department of International Health, Bloomberg's School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
¹⁰ MTEK Sciences Inc, Vancouver, BC, Canada.
¹¹ Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.

^# Contributed equally.

Abstract

Background: There is limited information on the effectiveness of task shifting of mental health services in populations with HIV.

Objective: This trial aims to evaluate the effectiveness of group support psychotherapy delivered by trained lay health workers to persons living with HIV (PLWH) with depression in primary care.

Methods: Thirty eligible primary care health centers across three districts were randomly allocated to have their lay health workers trained to deliver group support psychotherapy (intervention arm) or group HIV education and treatment as usual (control arm) to PLWH with depression. Treated PLWH will be evaluated at baseline, after the end of treatment, and at 6-month intervals thereafter for 2 years. Primary outcomes will be the difference in follow-up proportions of participants with Mini International Neuropsychiatric Interview criteria for major depression and difference in follow-up function scores of participants in the intervention and control arms 6 months after the end of treatment. Secondary outcomes will include measures of self-esteem, posttraumatic stress symptoms, social support, stigma, adherence to antiretroviral therapy, viral load, and number of disability days, asset possession indices, and cost-effectiveness data. Primary and secondary outcomes as well as subgroup analyses will be conducted at the individual level using multilevel random effects regression analyses adjusting for clustering in health centers. A process evaluation using mixed methods to assess acceptability, feasibility, fidelity, causal mediating processes, and contextual influences in the trial will be conducted.

Results: The trial has been approved by the Makerere College of Health Sciences School of Health Sciences Research Ethics Committee, the AIDS Support Organization, and the Uganda National Council of Science and Technology. A data and safety monitoring board has been put in place to monitor trial progress. A total of 1140 persons living with HIV have been recruited to the trial. An analysis of baseline and 6-month data is in progress. The results of this trial will not only be presented at national and international conferences but also submitted for publication in peer-reviewed journals and as a report to the funding agencies.

Conclusions: This cluster randomized trial will provide critical evidence to support culturally sensitive group-based psychotherapy for depression treatment in sub-Saharan Africa. Process evaluation outcomes will provide contextual information that health care and public health stakeholders can use to guide implementation decisions for their particular setting.

Trial registration: Pan African Clinical Trials Registry (PACTR): 201608001738234; http://www.pactr.org/ATMWeb/ appmanager/atm/atmregistry?dar=true&tNo=PACTR201608001738234 (Archived by WebCite at http://www.webcitation.org/ 6vUAgAQlj).

Keywords: Uganda; cluster randomized trial; depression; group support psychotherapy; lay health workers; persons living with HIV/AIDS.

©Etheldreda Nakimuli-Mpungu, Seggane Musisi, Kizito Wamala, James Okello, Sheila Ndyanabangi, Ramin Mojtabai, Jean Nachega, Ofir Harari, Edward Mills. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 11.12.2017.