Depression affects one in four people living with HIV. People with both depression and HIV are more likely to have a poorer quality of life and worse physical outcomes. Depression can make HIV progress faster to AIDS, decrease adherence to HIV medication, and reduce long-term survival. Treatment for depression can, therefore, be a matter of life or death for those living with HIV.
The link between depression and HIV is especially critical in countries where people have poor access to mental health care. In Zimbabwe, depression affects at least a third of people seeking primary healthcare. Yet, the country has an extremely low ratio of psychiatrists and psychologists to the general population: fewer than 2 specialists per million people. Zimbabwe is also one of the countries, globally, with the highest prevalence of people living with HIV. This is accompanied by large numbers of people dropping out from HIV care.
Dr Melanie Abas, from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London has been awarded a grant of $3.8 mil from the US National Institute for Mental Health (NIMH) as Chief Investigator for a clinical trial in Zimbabwe to try and tackle this issue. She is hoping to demonstrate how treating depression in people living with HIV can improve physical health, suppression of the HIV virus, and quality of life.
Image 1: Women in Zimbabwe gathering as part of a project to overcome depression; Image 2: Clinic in Zimbabwe where the trial will be held; Image 3: Health workers learning about the project; Image 4: Dr Abas meets counsellor, Constance, who is helping to increase HIV treatment uptake; Image 5: Left to right - Dr Celestino Dhege (Medical Superintendent at the Marondera Hospital) Dr O’Cleirigh, Dr Melanie Abas, Ms Tarisai Bere (local senior clinical psychologist for the trial) and Dr Mangezi. Credit Rebecca Jopling)
The trial will be known as TENDAI, which stands for Task-shifting to treat Depression and non-Adherence to HIV medication. Tendai is a gender-neutral name meaning ‘thankful’ in the Shona language. The intervention uses “Opening Up the Mind” – a colloquial term for talk therapy – in which trained counsellors speak to people living with HIV, asking questions, motivating them and encouraging patients to generate solutions to problems underlying their depression and help them overcome their barriers to taking HIV medication. It will also include providing antidepressants for those who need additional treatment. The hope is that, together, this may help treat depression and improve the number of people who regularly take their HIV medication.
Dr Abas explains, ‘There is a vast treatment gap for depression and other mental disorders in low resource settings, such as Zimbabwe. The TENDAI trial may demonstrate the first cost-effective treatment for those coping with the dual challenges of HIV and depression in these settings.
If successful, TENDAI could make a critical difference to the health and survival of people managing the challenges of HIV treatment in Zimbabwe, and potentially in other sub-Saharan African countries. Of the trial, Dr Tsitsi Apollo, Deputy Director AIDS and TB Unit, Ministry of Health Zimbabwe, said, ‘TENDAI is an excellent opportunity for collaboration between the Zimbabwe Ministry of Health and Child Care and researchers from different backgrounds, to explore and find interventions that are context-relevant to address depression and poor adherence for those with HIV who are virally non-suppressed’
The team’s work is already having a major impact as, in December 2018, a report about HIV and mental wellbeing from the Joint United Nations Programme on HIV/AIDS (UNAIDS) included recommendations made by Dr Abas and the team from work leading up to the TENDAI trial. Their research was also mentioned in the context of the of the UN’s 90-90-90 goals, which hope to bring to an end to the global AIDS epidemic by 2030.
The TENDAI-research team includes Dr Barbara Barratt and Dr Kimberley Goldsmith of King’s College London together with other experienced investigators from the University of Zimbabwe’s College of Health Sciencesand from Harvard Medical School who bring together a history of successful trials in HIV and depression.