Task Shifting to Treat Depression and HIV Medication Nonadherence in Low Resource Settings

Depression is commonly co-morbid with HIV infection in Zimbabwe and is consistently associated with worse adherence to antiretroviral therapy (ART). A task-shifted intervention for depression and ART adherence, suitable for delivery by non-specialists, could make a critical difference to the health and survival of people managing the challenges of HIV treatment in Zimbabwe. The TENDAI trial is a two-arm randomized controlled trial of an intervention for people on ART with viral non-suppression and clinically significant depression. It will be delivered at an HIV clinic in Marondera. TENDAI is a collaboration between the Department of Psychiatry, University of Zimbabwe College of Health Sciences, King's College London Institute of Psychiatry, Psychology and Neuroscience (London UK), and the Department of Psychiatry at Massachusetts General Hospital / Harvard Medical School.

Inclusion criteria

• Initiated on ART for at least 6 months
• Clinically significant depression symptoms scoring >/= 10 on the Patient Health Questionnaire-9
• Viral non-suppression in past two months per local clinic standard (VL > 1000 copies/mL)
• Able to provide informed consent
• If prescribed antidepressants, on stable regimen for at least 2 months

Exclusion criteria

• Unable to provide informed consent
• Active major mental illness (e.g. untreated psychosis or mania, actively suicidal), major untreated or undertreated mental illness or advanced physical disease or severe cognitive impairment assessed using the psychosis module of the MINI, the PHQ-9, and the International HIV dementia Scale which would interfere with engagement in PST-AD
• Has ever received PST or CBT for depression
• Less than 18 years of age