PhD research points to effective treatment of depression in people living with HIV/AIDS

Dr Biksegn Asrat, a University of Cape Town (UCT) PhD graduate, focused his doctoral research on depression and HIV/AIDS – particularly at adapting and piloting group interpersonal therapy for treatment of depressive symptoms for people living with HIV/AIDS.

“I studied public mental health, particularly focusing on people with HIV/AIDS. The aim of my study was to identify a type of psychological intervention that can be effective and acceptable for depressed people with HIV/AIDS,” he said.

The overall finding of his study was that psychological intervention, particularly interpersonal therapy (IPT), can be effective in reducing depressive symptoms.

“Most of the risk factors that left people with HIV/AIDS vulnerable to depression were interpersonal and psychosocial problems.”

After spending three years in Cape Town as an African Mental Health Research Initiative (AMARI) fellow to complete his doctoral studies, Dr Asrat is now back home in Ethiopia, where he is teaching at the University of Gondar. AMARI is a mental health capacity-building grant funded through Developing Excellence in Leadership, Training and Science (DELTAS) in Africa, a programme of the African Academy of Sciences (AAS), implemented with the support of Wellcome and the United Kingdom’s Department of International Development.

Mental health research

Prior to registering at UCT, Asrat completed his undergraduate studies at the University of Gondar and his MA at Jimma University. He was attracted to UCT because of the institution’s position as the leading university in Africa, and particularly for its strength in mental health research.

In conducting his research, Asrat explored existing psychological interventions to treat depression in people living with HIV/AIDS in low‑ and middle‑income countries, using a systematic review and meta‑analysis approach. He conducted a review of about 19 previous studies, which looked at the efficacy of different psychological treatments to address depressive disorders. The different interventions included cognitive behavioural therapy, interpersonal therapy (IPT), problem‑solving therapy, group support psychotherapy, and counselling/psycho‑education models.

After the review, and consultation with his supervisor and others, Asrat grew confident that IPT could be a good fit for people with HIV/AIDS.

“Most of the risk factors that left people with HIV/AIDS vulnerable to depression were interpersonal and psychosocial problems,” he said .

Life changes after being diagnosed with HIV/AIDS left many people with difficulties, such as divorce, separation, death of loved ones, the inability to work, unemployment, conflict with parents and families, and poverty.

“With all these risk factors, interpersonal therapy is a proven interventional strategy.”

The research was conducted in Bahir Dar, Ethiopia, in a specialised regional hospital where more than 6 000 clients receive their HIV treatments. Participants in the study were selected from the hospital. A group format was chosen, after a qualitative study showed that people preferred a group intervention over an individual one.

“With all these risk factors, interpersonal therapy is a proven interventional strategy.”

Asrat constructed groups for IPT intervention consisting of five to 10 people per group. There was rapid uptake into these groups, which was indicative of people’s receptiveness to this approach. The intervention was conducted over eight consecutive weekly sessions. Each client had a separate private individual session prior to joining the group sessions. About 93% of the participants completed the intervention, indicating high acceptability and feasibility of the intervention for people living with HIV/AIDS.

Strengthening health systems 

Associate Professor Marguerite Schneider from UCT’s Department of Psychiatry and Mental Health, and Asrat’s supervisor, said: “Dr Asrat’s consistent effort and ability to work closely with the team at the HIV Clinic in Bahir Dar proved very effective in ensuring a strong buy‑in for the study by the clinic staff.

“His study is an important stepping stone in conducting further research on testing the cost‑effectiveness and scalability of this IPT group intervention. Given the growing recognition of the role of mental health problems – such as depression – on the management of chronic conditions such as HIV, this research contributes a significant piece of evidence to strengthen health systems and address mental health problems in an integrated manner.” 

Asrat presented his thesis during a public seminar, organised by the Division of Public Mental Health. within the department. A recording of this seminar is available online. 

In addition to his thesis, Asrat, Associate Professor Schneider and co‑supervisors Professor Crick Lund and Associate Professor Fentie Ambaw, have published four academic papers on his research to investigate the efficacy, acceptability and feasibility of IPT for treatment of depression in people living with HIV/AIDS.

Asrat is currently exploring opportunities for funding to upscale the programme. If adequate funding is found, Asrat wants to expand the intervention to more people, so that it becomes possible to evaluate the results in a larger population.