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Health Equity in Africa

Depression and HIV: A Group-Based Counselling Intervention for Depression Co-morbid with HIV using a Task Shifting Approach, 2011-2012

Depression and HIV: A Group-Based Counselling Intervention for Depression Co-morbid with HIV using a Task Shifting Approach, 2011-2012


In South Africa, the rising co-morbidity of mental disorders with other non-communicable and communicable diseases, particularly in people living with HIV and AIDS (PLWHA), has helped raise the public health priority of mental health. Depression, in particular, compromises anti-retroviral treatment (ART) adherence and virological suppression, thus threatening the effectiveness of South Africa’s ART programme. There is a great deal of evidence-based treatment for depression and the response of the large number of PLWHA in southern Africa who are in need of mental health interventions. This increased need for mental health services demands an understanding of how best to provide culturally competent care within existing resource constraints. It also requires an understanding of how to provide interventions in a sustainable manner within the existing health system. The study included a qualitative investigation of the cultural understanding and context of depression in a cohort in South Africa. It also included a pilot Random Controlled Trial (RCT) of a custom made intervention – consisting of inter-personal therapy and problem solving approaches – using a task shifting model. The study informed the development of the COBALT RCT currently under way in South Africa. The study was led by Inge Peterson (PI, UKZN) and Dr Jill Hanass-Hancock (HEARD).


  • Phase 1: To explore the context and local understanding of depression in women living with HIV to inform the development of contextually appropriate mental health services that could be delivered within existing resource constraints in South Africa.
  • Phase 2: to assess the feasibility of a group-based counselling intervention for depressed HIV-positive patients in primary health care in South Africa using a task shifting approach.

Methodological Approach:

  • Phase 1: Semi-structured qualitative interviews were held with 35 women living with HIV in South Africa who met the diagnostic criteria for a major depressive episode.
  • Phase 2: Using a randomized control design, 76 HIV-positive patients with co-morbid depression were initially recruited. This was reduced to 34 in the final cohort. Participants were assessed using the Patient Health Questionnaire (PHQ9), Hopkins Symptom Checklist (HSCL-25) and Multi-dimensional Scale of Perceived Social Support (MSPSS) at baseline and 3 month follow-up. The intervention was adapted from a local group-based Interpersonal Therapy (IPT) intervention. Process evaluation interviews were held with the HIV counsellors who delivered the intervention and a sub-sample of participants.