The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective
Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depre...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-01-01
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| Series: | Global Public Health |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/17441692.2023.2201327 |
| _version_ | 1827811327636144128 |
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| author | Kazione Kulisewa Caroline E. Minnick Melissa A. Stockton Bradley N. Gaynes Mina C. Hosseinipour Steven Mphonda Griffin Sansbury Michael M. Udedi Brian W. Pence |
| author_facet | Kazione Kulisewa Caroline E. Minnick Melissa A. Stockton Bradley N. Gaynes Mina C. Hosseinipour Steven Mphonda Griffin Sansbury Michael M. Udedi Brian W. Pence |
| author_sort | Kazione Kulisewa |
| collection | DOAJ |
| description | Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depression in sub-Saharan Africa. We conducted in-depth interviews from June to December 2018 with eleven patients enrolled in Project SOAR-Mental Health, a pilot project integrating depression treatment into HIV care in Malawi. Patients treated with amitriptyline or fluoxetine participated in interviews exploring antidepressant acceptability through patient knowledge, side effect severity, pill burden, adherence, perceived efficacy, and tolerability. Patients described a lack of detailed antidepressant education from their providers. Variable, typically self-limiting side effects were reported from both amitriptyline and fluoxetine. While most side effects were mild, three patients reported functional impairment. Patients reported high adherence, though the additional pill burden was a challenge. Most patients found the antidepressants efficacious, tolerable, beneficial and acceptable. Although patient psychoeducation is notably lacking as a facet of clinical management, antidepressant prescription by primary care providers appears acceptable for comorbid severe depression in PLWH initiating HIV care in sub-Saharan Africa. Health workers should be mindful of dosing to minimise side effects and considerate of the additional pill burden. Trial registration: ClinicalTrials.gov ID [NCT03555669]. Retrospectively registered on 13 June 2018. |
| first_indexed | 2024-03-11T23:03:41Z |
| format | Article |
| id | doaj.art-82f90827c9b94532be89a676f9c3661e |
| institution | Directory Open Access Journal |
| issn | 1744-1692 1744-1706 |
| language | English |
| last_indexed | 2024-03-11T23:03:41Z |
| publishDate | 2023-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Public Health |
| spelling | doaj.art-82f90827c9b94532be89a676f9c3661e2023-09-21T13:56:58ZengTaylor & Francis GroupGlobal Public Health1744-16921744-17062023-01-0118110.1080/17441692.2023.22013272201327The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspectiveKazione Kulisewa0Caroline E. Minnick1Melissa A. Stockton2Bradley N. Gaynes3Mina C. Hosseinipour4Steven Mphonda5Griffin Sansbury6Michael M. Udedi7Brian W. Pence8Kamuzu University of Health SciencesUniversity of North Carolina at Chapel Hill Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill School of MedicineUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiUniversity of North Carolina Project-MalawiMinistry of HealthUniversity of North Carolina at Chapel Hill Gillings School of Global Public HealthDepression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depression in sub-Saharan Africa. We conducted in-depth interviews from June to December 2018 with eleven patients enrolled in Project SOAR-Mental Health, a pilot project integrating depression treatment into HIV care in Malawi. Patients treated with amitriptyline or fluoxetine participated in interviews exploring antidepressant acceptability through patient knowledge, side effect severity, pill burden, adherence, perceived efficacy, and tolerability. Patients described a lack of detailed antidepressant education from their providers. Variable, typically self-limiting side effects were reported from both amitriptyline and fluoxetine. While most side effects were mild, three patients reported functional impairment. Patients reported high adherence, though the additional pill burden was a challenge. Most patients found the antidepressants efficacious, tolerable, beneficial and acceptable. Although patient psychoeducation is notably lacking as a facet of clinical management, antidepressant prescription by primary care providers appears acceptable for comorbid severe depression in PLWH initiating HIV care in sub-Saharan Africa. Health workers should be mindful of dosing to minimise side effects and considerate of the additional pill burden. Trial registration: ClinicalTrials.gov ID [NCT03555669]. Retrospectively registered on 13 June 2018.http://dx.doi.org/10.1080/17441692.2023.2201327depressionantidepressantsacceptabilityhivqualitative research |
| spellingShingle | Kazione Kulisewa Caroline E. Minnick Melissa A. Stockton Bradley N. Gaynes Mina C. Hosseinipour Steven Mphonda Griffin Sansbury Michael M. Udedi Brian W. Pence The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective Global Public Health depression antidepressants acceptability hiv qualitative research |
| title | The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective |
| title_full | The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective |
| title_fullStr | The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective |
| title_full_unstemmed | The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective |
| title_short | The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective |
| title_sort | acceptability of antidepressant treatment in people living with hiv in malawi a patient perspective |
| topic | depression antidepressants acceptability hiv qualitative research |
| url | http://dx.doi.org/10.1080/17441692.2023.2201327 |
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