Chinoda Silindweyinkosi, Mutsinze Abigail, Simms Victoria, Beji-Chauke Rhulani, Verhey Ruth, Robinson Joanna, Barker Taryn, Mugurungi Owen, Apollo Tsitsi, Munetsi Epiphany, Sithole Dorcas, Weiss Helen A, Chibanda Dixon, Willis Nicola
Friendship Bench, Harare, Zimbabwe.
Africaid, Harare, Zimbabwe.
Glob Ment Health (Camb). 2020 Aug 28;7:e23. doi: 10.1017/gmh.2020.14. eCollection 2020.
Adolescents living with HIV (ALHIV) experience a high burden of mental health disorder which is a barrier to antiretroviral therapy adherence. In Zimbabwe, trained, mentored peer supporters living with HIV (Community Adolescent Treatment Supporters - CATS) have been found to improve adherence, viral suppression and psychosocial well-being among ALHIV. The Friendship Bench is the largest integrated mental health programme in Africa. We hypothesise that combining the CATS programme and Friendship Bench will improve mental health and virological suppression among ALHIV compared with the CATS programme alone.
We will conduct a cluster-randomised controlled trial in 60 clinics randomised 1:1 in five provinces. ALHIV attending the control arm clinics will receive standard CATS support and clinic support following the Ministry of Health guidelines. Those attending the intervention arm clinics will receive Friendship Bench problem-solving therapy, delivered by trained CATS. Participants with the signs of psychological distress will be referred to the clinic for further assessment and management. The primary outcome is HIV virological failure (≥1000 copies/ml) or death at 48 weeks. Secondary outcomes include the proportion of adolescents with common mental disorder symptoms (defined as Shona Symptom Questionnaire (SSQ-14) score ≥8), proportion with depression symptoms (defined as Patient Health Questionnaire (PHQ-9) score ≥11), symptom severity (mean SSQ-14 and PHQ-9 scores) and EQ-5D score for health-related quality of life.
This trial evaluates the effectiveness of peer-delivery of mental health care on mental health and HIV viral load among ALHIV. If effective this intervention has the potential to be scaled-up to improve these outcomes.Trial registration: PACTR201810756862405. 08 October 2018.
感染艾滋病毒的青少年（ALHIV）面临着心理健康障碍的沉重负担，这是抗逆转录病毒疗法依从性的一个障碍。在津巴布韦，已发现受过培训、得到指导的感染艾滋病毒的同伴支持者（社区青少年治疗支持者——CATS）可提高ALHIV的依从性、病毒抑制率和心理社会幸福感。友谊长椅是非洲最大的综合心理健康项目。我们假设，与单独的CATS项目相比，将CATS项目和友谊长椅项目相结合将改善ALHIV的心理健康和病毒学抑制情况。
我们将在五个省份的60家诊所进行一项整群随机对照试验，诊所按1:1随机分组。对照组诊所的ALHIV将按照卫生部指南接受标准的CATS支持和诊所支持。干预组诊所的ALHIV将接受由训练有素的CATS提供的友谊长椅问题解决疗法。有心理困扰迹象的参与者将被转介到诊所进行进一步评估和管理。主要结局是48周时的艾滋病毒病毒学失败（≥1000拷贝/毫升）或死亡。次要结局包括有常见精神障碍症状的青少年比例（定义为绍纳症状问卷（SSQ - 14）得分≥8）、有抑郁症状的比例（定义为患者健康问卷（PHQ - 9）得分≥11）、症状严重程度（SSQ - 14和PHQ - 9平均得分）以及与健康相关生活质量的EQ - 5D得分。
本试验评估了同伴提供心理健康护理对ALHIV心理健康和艾滋病毒病毒载量的有效性。如果有效，这种干预措施有可能扩大规模以改善这些结局。试验注册号：PACTR201810756862405。2018年10月8日。
