Integrating the management of depression into routine HIV care in Uganda (the HIV+D trial) (360G-Wellcome-205069_Z_16_Z)

This project aims to demonstrate the feasibility and effectiveness of a mental health integration model in general adult HIV care services to bridge the treatment gap for mental disorders in HIV/AIDS that currently exists in most of sub-Saharan Africa. The proposed model will be based on the MANAS intervention which is stepped care collaborative care delivery model coordinated by a lay health worker for depressive and anxiety disorders in public primary health care attenders in India. This study will have the following objectives: i) to adapt the MANAS collaborative stepped care intervention to the general HIV care situation of Uganda, including the local adapatation of the Health Activity Program (HAP) therapy for depression; ii) to undertake a cluster randomised trial to evaluate the effectiveness on depressive disorders (DD) and functional outcomes and cost-effectiveness of the intervention in routine HIV care in Uganda. This study will be undertaken among persons living with HIV attending public health care facilities in three districts of Uganda. The planned intervention will involve screening for DD, psychoeducation, administration of HAP and use of antidepressant medication to be delivered by lay health workers, the HIV care team with support from specialist mental health workers.