Effect of the Friendship Bench Intervention on Antiretroviral Therapy Outcomes and Mental Health Symptoms in Rural Zimbabwe
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Published:2023-07-13
Issue:7
Volume:6
Page:e2323205
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Haas Andreas D.1, Kunzekwenyika Cordelia2, Manzero Josphat2, Hossmann Stefanie1, Limacher Andreas3, van Dijk Janneke H.2, Manhibi Ronald2, von Groote Per1, Hobbins Michael A.4, Verhey Ruth5, Egger Matthias167, Kateta Amos8, Mutonhodza Cuthbert8, Machiha Favourite8, Mhlanga Ntandoyenkosi8, Matutururu Shingai8, Gombwiro Tatenda8, Gweredza Millicent8, Saide Josephine Yasmin8, Muchakubvura Beauty8, Mhlanga Kudzai8, Mwakasa Dennis8, Zvekare Fungai Nyikadzino8, Maumbe Yvonne Chiedza8, Maposa Boldwin8, Gumbo Sibongile8, Kamusha Japhet8, Tshuma Morris8, Runyowa Rejoyce8, Pikayi Abigail8, Mbiba Fredrick8, Mutungama Chiedza Elizabeth8, Mukuwapasi Waraidzo AM8, Mandabva Rudo8, Trelle Sven8, Manda Ethel8, Majichi Duncan Tatenda8,
Affiliation:
1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland 2. SolidarMed, Masvingo, Zimbabwe 3. Clinical Trials Unit Bern, University of Bern, Bern, Switzerland 4. SolidarMed, Luzern, Switzerland 5. Friendship Bench, Harare, Zimbabwe 6. Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa 7. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom 8. for the Friendship Bench ART trial group
Abstract
ImportanceCommon mental disorders (CMD), which include depression and anxiety, are prevalent among people living with HIV and are associated with suboptimal antiretroviral therapy (ART) adherence.ObjectiveTo assess the effect of a lay health worker–led psychological intervention on ART adherence, virologic suppression, and mental health symptoms.Design, Setting, and ParticipantsOpen-label pragmatic cluster trial with 1:1 block randomization of 16 health facilities in rural Bikita, Zimbabwe. Recruitment occurred from October 2018 to December 2019, and participants were followed up for 12 months, ending in December 2020. Participants were adults aged 18 years and older, who spoke English or Shona, screened positive for CMD (Shona Symptoms Questionnaire [SSQ]-14 score ≥9), received first-line ART for 6 or more months, had no World Health Organization stage 4 disease, no psychosis, were not pregnant, and provided informed consent. Data were analyzed from March 2021 to February 2022.InterventionThe Friendship Bench, consisting of 6 lay health worker–led weekly problem-solving therapy sessions and optional peer-led group support.Main Outcomes and MeasuresThe primary outcome was mean adherence during 2 to 6 months of follow-up, and the secondary outcomes were mean adherence during 1 to 12 months of follow-up, change in SSQ-14 and Patient Health Questionnaire (PHQ-9) scores (3, 6, 9, and 12 months), and viral load suppression (6 and 12 months).ResultsA total of 516 participants were recruited (244 in Friendship Bench and 272 in enhanced standard care facilities); 438 (84.9%) were female and the mean (SD) age was 45.6 (10.9) years. Mean (SD) adherence between 2 to 6 months was 89.9% (18.4%) in the Friendship Bench group and 87.2% (20.1%) in the control group. The intervention had no statistically significant effect on adherence between 2 to 6 months (unadjusted mean difference, 1.93 percentage points; 95% CI, −1.20 to 5.06 percentage points; P = .23), between months 1 to 12 (mean difference 0.79 percentage points; 95% CI, −2.14 to 3.71 percentage points; P = .60), or viral suppression. Declines in SSQ-14 scores from baseline to 3 months (difference, −1.65; 95% CI, −3.07 to −0.24), 6 months (difference, −1.57; 95% CI, −2.98 to −0.15), and 9 months (difference, −1.63; 95% CI, −3.05 to −0.22) were greater in the Friendship Bench than the standard care group (P < .05). There were no differences in the decline in the SSQ-14 scores from baseline to 12 months and in declines in PHQ-9 scores from baseline to 3, 6, 9, and 12 months.Conclusions and RelevanceIn this randomized trial of HIV-positive participants with CMD, the Friendship Bench intervention had no effect on adherence and viral suppression, possibly due to the absence of skill-based adherence training and a ceiling effect.Trial RegistrationClinicalTrials.gov Identifier: NCT03704805
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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