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Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries

  • K. J. Sikkema (a1) (a2), A. C. Dennis (a2), M. H. Watt (a2), K. W. Choi (a1) (a2), T. T. Yemeke (a2) and J. A. Joska (a3)...

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 11 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.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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* Address for correspondence: K. J. Sikkema, Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, USA. (Email:
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Adams, JL, Almond, ML, Ringo, EJ, Shangali, WH, Sikkema, KJ (2012 a). Feasibility of nurse-led antidepressant medication management of depression in an HIV clinic in Tanzania. International Journal of Psychiatry in Medicine 43, 105117.
Adams, JL, Gaynes, BN, McGuinness, T, Modi, R, Willig, J, Pence, BW (2012 b). Treating depression within the HIV ‘medical home’: a guided algorithm for antidepressant management by HIV clinicians. AIDS Patient Care and STDS 26, 647654.
Bass, JK, Bolton, PA, Murray, LK (2007). Do not forget culture when studying mental health. Lancet 370, 918919.
Bhana, A, Mellins, CA, Petersen, I, Alicea, S, Myeza, N, Holst, H, Abrams, E, John, S, Chhagan, M, Nestadt, DF, Leu, CS, Mckay, M (2014). The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care 26, 111.
Bing, EG, Burnam, MA, Longshore, D, Fleishman, JA, Sherbourne, CD, London, AS, Turner, BJ, Eggan, F, Beckman, R, Vitiello, B, Morton, SC, Orlando, M, Bozzette, SA, Ortiz-Barron, L, Shapiro, M (2001). Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of General Psychiatry 58, 721728.
Bing, EG, Hays, RD, Jacobson, LP, Chen, B, Gange, SJ, Kass, NE, Chmiel, JS, Zucconi, SL (2000). Health-related quality of life among people with HIV disease: results from the Multicenter AIDS Cohort Study. Quality of Life Research 9, 5563.
Boivin, MJ, Bangirana, P, Nakasujja, N, Page, CF, Shohet, C, Givon, D, Bass, JK, Opoka, RO, Klein, PS (2013). A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus. Journal of Pediatrics 163, 14091416.e5.
Bolton, P, Bass, J, Neugebauer, R, Verdeli, H, Clougherty, KF, Wickramaratne, P, Speelman, L, Weissman, M (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. Journal of the American Medical Association 18, 31173124.
Breuer, E, Myer, L, Struthers, H, Joska, JA (2011). HIV/AIDS and mental health research in sub-Saharan Africa: a systematic review. African Journal of AIDS Research 10, 101122.
Breuer, E, Stoloff, K, Myer, L, Seedat, S, Stein, DJ, Joska, JA (2014). The validity of the substance abuse and mental illness symptom screener (SAMISS) in people living with HIV/AIDS in primary HIV care in Cape Town, South Africa. AIDS and Behavior 18, 11331141.
Brown, JL, Vanable, PA (2011). Stress management interventions for HIV-infected individuals: review of recent intervention approaches and directions for future research. Journal of Neurobehavioral HIV Medicine 2011, 95106.
Carrico, AW, Nation, A, Gomez, W, Sundberg, J, Dilworth, SE, Johnson, MO, Moskowitz, JT, Rose, CD (2015). Pilot trial of an expressive writing intervention with HIV-positive methamphetamine-using men who have sex with men. Psychology of Addictive Behaviors 29, 277282.
Chan, I, Kong, P, Leung, P, Au, A, Li, P, Chung, R, Po, LM, Yu, P (2005). Cognitive-behavioral group program for Chinese heterosexual HIV-infected men in Hong Kong. Patient Education and Counseling 56, 7884.
Chibanda, D, Benjamin, L, Weiss, HA, Abas, M (2014). Mental, neurological, and substance use disorders in people living with HIV/AIDS in low- and middle-income countries. Journal of Acquired Immune Deficiency Syndrome 67(Suppl. 1), S54S67.
Ciesla, JA, Roberts, JE (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry 158, 725730.
Clucas, C, Sibley, E, Harding, R, Liu, L, Catalan, J, Sherr, L (2011). A systematic review of interventions for anxiety in people with HIV. Psychol Health Med 16, 528547.
Cohen, MS, Chen, YQ, Mccauley, M, Gamble, T, Hosseinipour, MC, Kumarasamy, N, Hakim, JG, Kumwenda, J, Grinsztejn, B, Pilotto, JH, Godbole, SV, Mehendale, S, Chariyalertsak, S, Santos, BR, Mayer, KH, Hoffman, IF, Eshleman, SH, Piwowar-Manning, E, Wang, L, Makhema, J, Mills, LA, De Bruyn, G, Sanne, I, Eron, J, Gallant, J, Havlir, D, Swindells, S, Ribaudo, H, Elharrar, V, Burns, D, Taha, TE, Nielsen-Saines, K, Celentano, D, Essex, M, Fleming, TR, Team, HS (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine 365, 493505.
Collins, PY, Holman, AR, Freeman, MC, Patel, V (2006). What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS 20, 15711582.
Crepaz, N, Marks, G (2001). Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychology 20, 291299.
Crepaz, N, Passin, WF, Herbst, JH, Rama, SM, Malow, RM, Purcell, DW, Wolitski, RJ, HIV AIDS Prevention Research Synthesis Team (2008). Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning. Health Psychology 27, 414.
Drozd, F, Skeie, LG, Kraft, P, Kvale, D (2014). A web-based intervention trial for depressive symptoms and subjective well-being in patients with chronic HIV infection. AIDS Care 26, 10801089.
Eller, LS, Kirksey, KM, Nicholas, PK, Corless, IB, Holzemer, WL, Wantland, DJ, Willard, SS, Robinson, L, Hamilton, MJ, Sefcik, EF, Moezzi, S, Mendez, MR, Rosa, M, Human, S (2013). A randomized controlled trial of an HIV/AIDS Symptom Management Manual for depressive symptoms. AIDS Care 25, 391399.
Eloff, I, Finestone, M, Makin, JD, Boeving-Allen, A, Visser, M, Ebersohn, L, Ferreira, R, Sikkema, KJ, Briggs-Gowan, MJ, Forsyth, BW (2014). A randomized clinical trial of an intervention to promote resilience in young children of HIV-positive mothers in South Africa. AIDS 28(Suppl. 3), S347S357.
Field, W, Kruger, C (2008). The effect of an art psychotherapy intervention on levels of depression and health locus of control orientations experienced by black women living with HIV. South African Journal of Psychology 38, 467478.
Gayner, B, Esplen, MJ, Deroche, P, Wong, J, Bishop, S, Kavanagh, L, Butler, K (2012). A randomized controlled trial of mindfulness-based stress reduction to manage affective symptoms and improve quality of life in gay men living with HIV. Journal of Behavioral Medicine 35, 272285.
Gonzalez, A, Barinas, J, O'Cleirigh, C (2011). Substance use: impact on adherence and HIV medical treatment. Current HIV/AIDS Reports 8, 223234.
Gonzalez-Garcia, M, Ferrer, MJ, Borras, X, Munoz-Moreno, JA, Miranda, C, Puig, J, Perez-Alvarez, N, Soler, J, Feliu-Soler, A, Clotet, B, Fumaz, CR (2014). Effectiveness of mindfulness-based cognitive therapy on the quality of life, emotional status, and CD4 cell count of patients aging with HIV infection. AIDS and Behavior 18, 676685.
Gupta, S, Williams, B, Montaner, J (2014). Realizing the potential of treatment as prevention: global ART policy and treatment coverage. Current HIV/AIDS Reports 11, 479486.
Harding, R, Liu, L, Catalan, J, Sherr, L (2011). What is the evidence for effectiveness of interventions to enhance coping among people living with HIV disease? A systematic review. Psychology, Health and Medicine 16, 564587.
Hartzell, JD, Janke, IE, Weintrob, AC (2008). Impact of depression on HIV outcomes in the HAART era. Journal of Antimicrobial Chemotherapy 62, 246255.
Heckman, TG, Heckman, BD, Anderson, T, Lovejoy, TI, Mohr, D, Sutton, M, Bianco, JA, Gau, JT (2013). Supportive-expressive and coping group teletherapies for HIV-infected older adults: a randomized clinical trial. AIDS and Behavior 17, 30343044.
Hersch, RK, Cook, RF, Billings, DW, Kaplan, S, Murray, D, Safren, S, Goforth, J, Spencer, J (2013). Test of a web-based program to improve adherence to HIV medications. AIDS and Behavior 17, 29632976.
Himelhoch, S, Medoff, D, Maxfield, J, Dihmes, S, Dixon, L, Robinson, C, Potts, W, Mohr, DC (2013). Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV/AIDS: results of a randomized controlled trial. AIDS and Behavior 17, 27562764.
Ironson, G, O'cleirigh, C, Leserman, J, Stuetzle, R, Fordiani, J, Fletcher, M, Schneiderman, N (2013). Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial. J Consult Clin Psychol 81, 284298.
Jirapaet, V (2000). Effects of an empowerment program on coping, quality of life, and the maternal role adaptation of Thai HIV-infected mothers. Journal of the Association of Nurses in AIDS Care: JANAC 11, 3445.
Joska, J, Sorsdahl, KR (2012). Integrating mental health into general health care: lessons from HIV. African Journal of Psychiatry 15, 420423.
Kaaya, SF, Blander, J, Antelman, G, Cyprian, F, Emmons, KM, Matsumoto, K, Chopyak, E, Levine, M, Smith Fawzi, MC (2013). Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status. AIDS Care 25, 854862.
Kader, R, Seedat, S, Koch, JR, Parry, CD (2012). A preliminary investigation of the AUDIT and DUDIT in comparison to biomarkers for alcohol and drug use among HIV-infected clinic attendees in Cape Town, South Africa. African Journal of Psychiatry 15, 346351.
Kakuma, R, Minas, H, Van Ginneken, N, Dal Poz, MR, Desiraju, K, Morris, JE, Saxena, S, Scheffler, RM (2011). Human resources for mental health care: current situation and strategies for action. Lancet 378, 16541663.
Li, L, Lee, SJ, Jiraphongsa, C, Khumtong, S, Thammawijaya, P, Rotheram-Borus, MJ (2010). Improving the health and mental health of people living with HIV/AIDS: 12-month assessment of a behavioral intervention in Thailand. American Journal of Public Health 100, 24182425.
Li, L, Ji, G, Liang, LJ, Ding, Y, Tian, J, Xiao, Y (2011). A multilevel intervention for HIV-affected families in China: Together for empowerment activities (TEA). Social Science and Medicine 73, 12141221.
Li, L, Liang, LJ, Lee, SJ, Iamsirithaworn, S, Wan, D, Rotheram-Borus, MJ (2012). Efficacy of an intervention for families living with HIV in Thailand: a randomized controlled trial. AIDS and Behavior 16, 12761285.
Li, L, Liang, LJ, Ji, G, Wu, J, Xiao, Y (2014). Effect of a family intervention on psychological outcomes of children affected by parental HIV. AIDS and Behavior 18, 20512058.
Lund, C. (2014). Mental health services for HIV in resource-limited settings. In HIV and Psychiatry (ed. Joska, J. A., Stein, D. J. and Grant, I.). Wiley-Blackwell: West Sussex, UK, 235239.
Machtinger, EL, Wilson, TC, Haberer, JE, Weiss, DS (2012). Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS and Behavior 16, 20912100.
Mayston, R, Kinyanda, E, Chishinga, N, Prince, M, Patel, V (2012). Mental disorder and the outcome of HIV/AIDS in low-income and middle-income countries: a systematic review. AIDS 26(Suppl. 2), S117S135.
Meade, CS, Drabkin, AS, Hansen, NB, Wilson, PA, Kochman, A, Sikkema, KJ (2010). Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories. Addiction 105, 19421951.
Miller, S, Rotheram-Borus, MJ (1994). Project T.A.L.C.: Teens and parents learning to communicate. Department of Psychiatry, Division of Social and Community Psychiatry, University of California, Los Angeles.
Molassiotis, A, Callaghan, P, Twinn, SF, Lam, SW, Chung, WY, Li, CK (2002). A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS Patient Care and STDS 16, 8396.
Mundell, JP, Visser, MJ, Makin, JD, Kershaw, TS, Forsyth, BWC, Jeffer, B, Sikkema, KJ (2011). The impact of structured support groups for pregnant South African women recently diagnosed HIV positive. Women and Health 51, 546565.
Nyamathi, A, Ekstrand, M, Salem, BE, Sinha, S, Ganguly, KK, Leake, B (2013). Impact of Asha intervention on stigma among rural Indian women with AIDS. Western Journal of Nursing Research 35, 867883.
Nyamathi, A, Salem, BE, Meyer, V, Ganguly, KK, Sinha, S, Ramakrishnan, P (2012). Impact of an Asha intervention on depressive symptoms among rural women living with AIDS in India: comparison of the Asha-Life and Usual Care program. AIDS Education and Prevention 24, 280293.
Olley, BO (2006). Improving well-being through psycho-education among voluntary counseling and testing seekers in Nigeria: a controlled outcome study. AIDS Care 18, 10251031.
Pacella, ML, Armelie, A, Boarts, J, Wagner, G, Jones, T, Feeny, N, Delahanty, DL (2012). The impact of prolonged exposure on PTSD symptoms and associated psychopathology in people living with HIV: a randomized test of concept. AIDS and Behavior 16, 13271340.
Patel, V, Araya, R, Chatterjee, S, Chisholm, D, Cohen, A, De Silva, M, Hosman, C, Mcguire, H, Rojas, G, Van Ommeren, M (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 370, 9911005.
Patel, V, Simon, G, Chowdhary, N, Kaaya, S, Araya, R (2009). Packages of care for depression in low- and middle-income countries. PLoS Medicine 6, e1000159.
Peltzer, K, Ramlagan, S, Jones, D, Weiss, SM, Fomundam, H, Chanetsa, L (2012). Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: results from a randomized trial. SAHARA-J: Journal of Social Aspects of HIV/AIDS 9, 218226.
Pence, BW, Gaynes, BN, Atashili, J, O'donnell, JK, Kats, D, Whetten, K, Njamnshi, AK, Mbu, T, Kefie, C, Asanji, S, Ndumbe, P (2014). Feasibility, safety, acceptability, and preliminary efficacy of measurement-based care depression treatment for HIV patients in Bamenda, Cameroon. AIDS and Behavior 18, 11421151.
Petersen, I, Hanass Hancock, J, Bhana, A, Govender, K (2014). A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study. Journal of Affective Disorders 158, 7884.
Rahman, A, Malik, A, Sikander, S, Roberts, C, Creed, F (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372, 902909.
Ravaei, F, Hosseinian, S, Tabatabaei, S (2013). Effectiveness of cognitive behavioral and spiritual trainings on improving mental health of HIV positive drug addicts. Archives of Clinical Infectious Diseases 8, 2326.
Richter, L, Rotheram-Borus, MJ, van Heerden, A, Stein, A, Tomlinson, M, Harwood, JM, Rochat, T, van Rooyen, H , Comulada, WS, Tang, Z (2014). Pregnant women living with HIV (WLH) supported at clinics by peer WLH: a cluster randomized controlled trial. AIDS and Behavior 18, 706715.
Rotheram-Borus, MJ, Richter, LM, van Heerden, A, van Rooyen, H, Tomlinson, M, Harwood, JM, Comulada, WS, Stein, A (2014). A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants. PLoS One 9, e84867.
Seedat, S (2012). Interventions to improve psychological functioning and health outcomes of HIV-infected individuals with a history of trauma or PTSD. Current HIV/AIDS Reports 9, 344350.
Senn, TE, Carey, MP, Vanable, PA (2010). The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. Journal of the National Medical Association 102, 614620.
Seyedalinaghi, S, Jam, S, Foroughi, M, Imani, A, Mohraz, M, David, GE, Black, DS (2012). Randomized controlled trial of mindfulness-based stress reduction delivered to human immunodeficiency virus-positive patients in Iran: effects on CD4 + T lymphocyte count and medical and psychological symptoms. Psychosomatic Medicine 74, 620627.
Sherr, L, Clucas, C, Harding, R, Sibley, E, Catalan, J (2011). HIV and depression–a systematic review of interventions. Psychology, Health and Medicine 16, 493527.
Sikkema, KJ, Ranby, KW, Meade, CS, Hansen, NB, Wilson, PA, Kochman, A (2013). Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse. Journal of Consulting and Clinical Psychology 81, 274283.
Sikkema, KJ, Watt, MH, Drabkin, AS, Meade, CS, Hansen, NB, Pence, BW (2010). Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS and Behavior 14, 252262.
Sikkema, KJ, Wilson, PA, Hansen, NB, Kochman, A, Neufeld, S, Ghebremichael, MS, Kershaw, T (2008). Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. Journal of Acquired Immune Deficiency Syndrome 47, 506513.
Sin, NL, DiMatteo, MR (2014). Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis. Annals of Behavioral Medicine 47, 259269.
Skinner, D, Mfecane, S (2004). Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. SAHARA-J: Journal of Social Aspects of HIV/AIDS 1, 157164.
Spies, G, Asmal, L, Seedat, S (2013). Cognitive-behavioural interventions for mood and anxiety disorders in HIV: a systematic review. Journal of Affective Disorders 150, 171180.
The World Bank Group (2015). Country and Lending Groups [Online]. The World Bank Group. (Accessed 5 November 2014).
Trivedi, MH, Rush, AJ, Gaynes, BN, Stewart, JW, Wisniewski, SR, Warden, D, Ritz, L, Luther, JF, Stegman, D, Deveaugh-Geiss, J, Howland, R (2007). Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR(*)D measurement-based care. Neuropsychopharmacology 32, 24792489.
Tsai, AC (2014). Reliability and validity of depression assessment among persons with HIV in Sub-Saharan Africa: systematic review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes 66, 503511.
Un Joint Programme On HIV/AIDS (2014). The Gap Report, 2014, Geneva, UNAIDS.
Uthman, OA, Magidson, JF, Safren, SA, Nachega, JB (2014). Depression and adherence to antiretroviral therapy in low- middle- and high-income countries: a systematic review and meta-analysis. Current HIV/AIDS Reports 11, 291307.
WHO (2001). The World Health Report 2001: Mentalh Health, New Understanding, New Hope, Geneva, WHO.
Wu, L, Li, X (2013). Community-based HIV/AIDS interventions to promote psychosocial well-being among people living with HIV/AIDS: a literature review. Healthy Psychology and Behavioral Medicine 1, 3146.
Yu, X, Lau, JTF, Mak, WWS, Cheng, Y, Lv, Y, Zhang, J (2014). A pilot theory–based intervention to improve resilience, psychosocial well-being, and quality of life among people living with HIV in rural China. Journal of Sex and Marital Therapy 40, 116.
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