Mental health interventions for persons living with HIV in low- and middle-income countries: a systematic review.

Journal Article (Systematic Review;Review;Journal Article)

Introduction

Addressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low- and middle-income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness.

Methods

We included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full-text screening for references meeting title/abstract criteria.

Results

We identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post-traumatic stress disorder (n = 1, 3.33%) and HIV-related neuro-cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = -1.56, 95% CI = -3.03 to -0.09, p = 0.037].

Conclusions

There continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low- and middle-income countries.

Full Text

Duke Authors

Cited Authors

  • Nakimuli-Mpungu, E; Musisi, S; Smith, CM; Von Isenburg, M; Akimana, B; Shakarishvili, A; Nachega, JB; Mills, EJ; Chibanda, D; Ribeiro, M; V Williams, A; Joska, JA

Published Date

  • June 2021

Published In

Volume / Issue

  • 24 Suppl 2 /

Start / End Page

  • e25722 -

PubMed ID

  • 34164926

Pubmed Central ID

  • PMC8222847

Electronic International Standard Serial Number (EISSN)

  • 1758-2652

International Standard Serial Number (ISSN)

  • 1758-2652

Digital Object Identifier (DOI)

  • 10.1002/jia2.25722

Language

  • eng