People living with human immunodeficiency virus (PLWH) has been reported to have a high prevalence of depressive symptoms. Low-income populations account for a large proportion of PLWH, hence indicating a high level of depressive symptoms in low-income PLWH. Telephone-based therapy has been shown to be effective for treating PLWH's depressive symptoms, but its effects among low-income PLWH remain unclear. The purpose of this meta-analysis was to evaluate the effects of telephone-based therapy targeting depressive symptoms among low-income PLWH. Six databases (PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, VIP Database and Wanfang Data) were searched until May 2020 using search terms related to telephone-based therapy, depressive symptoms, and PLWH. Eight studies were included in the meta-analysis. Both postintervention effects (primary outcome) and long-term effects (secondary outcome) were evaluated using a random effects model. The meta-analysis revealed a small to moderate effect size (ĝ = - 0.29, 95% CI - 0.51, - 0.06) on reducing depressive symptom scores (Z = 2.51, p = 0.01) in telephone-based intervention group compared with the control group at postintervention. However, there was no statistically significant long-term effects (Z = 0.77, p = 0.44) at follow-up. For postintervention effects, calculation of the I2 index indicated moderate heterogeneity (I2 = 50%); sensitivity analysis and subgroup analysis were performed to explore the source of heterogeneity. Ethnic group was classified into minority and majority which refers to most of the population were ethnic minority and majority respectively. Between-group differences were found across ethnic groups. The results suggested that there was a slightly stronger effect of telephone-based therapy in low-income PLWH than among PLWH in general, but its long-term effect requires future investigation. The effects of the intervention were better among the ethnic majority subgroups of low-income PLWH. Treatment format and intervention duration might also influence the intervention effects. However, the overall quality of evidence was low and directly impacted on the interpretation of our results, suggesting that more high-quality random controlled trial (RCT)/longitudinal studies with less selection and detection bias, less inconsistency and less indirectness are needed when applying telephone-based therapy to low-income PLWH with depressive symptoms in further studies.
Se ha informado de que las personas con el virus de la inmunodeficiencia humana (PLWH) tienen un alto riesgo de síntomas depresivos, y las personas de bajos ingresos ocupan una gran proporción de PLWH. El objetivo de este análisis es evaluar los efectos de la terapia telefónica para los síntomas depresivos en personas con PLWH de bajos ingresos. Se realizaron búsquedas en seis bases de datos hasta mayo de 2020, incluidos ocho estudios. En comparación con el grupo de control, el análisis reveló que en el grupo de intervención telefónica contaba con un efecto pequeño a moderado (ĝ = -0.29, IC 95% -0.51, -0.06) en la reducción de las puntuaciones de síntomas depresivos (Z = 2.51, p = 0.01). Sin embargo, no hubo efectos estadísticamente significativos a largo plazo (Z = 0.77, p = 0.44) en el seguimiento. Se encontraron diferencias entre grupos desde los grupos étnicos. Los resultados mostraron que el efecto de la terapia telefónica era levemente más fuerte que el de PLWH general en las PLWH de bajos ingresos, pero la evidencia general de baja calidad impactó en la interpretación de nuestros resultados.
Keywords: Depressive symptoms; Low-income; Meta-analysis; People living with HIV; Telephone-based therapy.