Group Therapy for Depression in People Living with HIV in Kampala, Uganda

Depression in people living with HIV (PWH) is associated with reduced medication adherence, viral suppression, and retention-in-care. In low-resourced settings, depression interventions are needed for PWH to improve outcomes. We conducted a randomized trial at a large, public HIV clinic. We enrolled PWH who started HIV medications <3 months prior and had depression. We randomized participants 1:1 to either an 8-week group therapy intervention or enhanced usual care. We measured depression with the Patient Health Questionnaire (PHQ-9) and Hamilton depression rating scale. Between 2021-2023, we enrolled 137 PWH. The median age was 30 years. The median CD4 count was 332 cells/mcL. Female participants made up 64%. Baseline depression metrics were not different between groups. Most subjects had mild depression. Moderate-severe depression (PHQ-9 > 10) was present in 37% of the intervention group and 38% of the control group. At three months, we found that the percentage of mild depression was significantly lower in the intervention compared to the control (11% (5/47) versus 34% (21/62), p=0.005). By 6 months, depression metrics were not statistically different as depression had resolved in 3% (3/102). The change in PHQ-9 was significantly greater in the intervention group compared to the control group. An 8-week group therapy depression intervention was successful in relieving depression in PWH at three months compared to enhanced usual care. Group therapy can be adapted to different settings and effectively improves mood in PWH. Further work is needed to adapt psychological interventions to different settings among people with HIV in low- and middle-income settings.