Sikkema Kathleen J, Dennis Alexis C, Watt Melissa H, Choi Karmel W, Yemeke Tatenda T, Joska John A
Duke University, Department of Psychology and Neuroscience, Durham, NC ; Duke Global Health Institute, Durham, NC.
Duke Global Health Institute, Durham, NC.
Glob Ment Health (Camb). 2015 Jan;2. doi: 10.1017/gmh.2015.17. Epub 2015 Sep 9.
People living with HIV (PLWH) experience greater psychological distress than the general population. Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms, quality of life, and HIV care engagement. However, little is known about the effectiveness of mental health interventions for PLWH in low and middle-income countries (LMICs), where the large majority of PLWH reside. This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these settings. A systematic search strategy was undertaken to identify peer-reviewed published papers of intervention trials addressing negative psychological states or disorders (e.g., depression, anxiety) among PLWH in LMIC settings. Search results were assessed against pre-established inclusion and exclusion criteria. Data from papers meeting criteria were extracted for synthesis. Twenty-six papers, published between 2000 and 2014, describing 22 unique interventions were identified. Trials were implemented in sub-Saharan Africa (n=13), Asia (n=7), and the Middle East (n=2), and addressed mental health using a variety of approaches, including cognitive-behavioral (n=18), family-level (n=2), and pharmacological (n=2) treatments. Four randomized controlled trials reported significant intervention effects in mental health outcomes, and eleven preliminary studies demonstrated promising findings. Among the limited mental health intervention trials with PLWH in LMICs, few demonstrated efficacy. Mental health interventions for PLWH in LMICs must be further developed and adapted for resource-limited settings to improve effectiveness.
与一般人群相比，艾滋病毒感染者（PLWH）面临更大的心理困扰。来自高收入国家的证据表明，针对艾滋病毒感染者的心理干预可以改善心理健康症状、生活质量以及对艾滋病毒治疗的参与度。然而，对于低收入和中等收入国家（LMICs）中大多数艾滋病毒感染者而言，心理健康干预的效果却鲜为人知。本系统综述旨在综合低收入和中等收入国家艾滋病毒感染者心理健康干预试验的结果，为这些地区心理健康服务的提供提供参考。我们采用了系统的检索策略，以识别在低收入和中等收入国家环境中针对艾滋病毒感染者负面心理状态或障碍（如抑郁症、焦虑症）发表的同行评审干预试验论文。根据预先确定的纳入和排除标准对检索结果进行评估。提取符合标准论文的数据进行综合分析。我们确定了2000年至2014年间发表的26篇论文，描述了22种独特的干预措施。试验在撒哈拉以南非洲（n = 13）、亚洲（n = 7）和中东（n = 2）实施，并采用多种方法解决心理健康问题，包括认知行为疗法（n = 18）、家庭层面疗法（n = 2）和药物疗法（n = 2）。四项随机对照试验报告了心理健康结果方面的显著干预效果，十一项初步研究显示出有前景的结果。在低收入和中等收入国家针对艾滋病毒感染者的有限心理健康干预试验中，很少有试验证明有效。低收入和中等收入国家针对艾滋病毒感染者的心理健康干预措施必须进一步开发并适应资源有限的环境，以提高有效性。
