Treating Depression to Improve HIV Care Outcomes in Malawi



The issue
Depression is common among people living with HIV in sub-Saharan Africa and likely represents an important barrier to consistent HIV care engagement and long-term viral suppression. However, the potential for depression treatment to improve HIV care outcomes has received little attention in the region, in part because of the very limited mental health infrastructure in many countries.


Our approach
Project SOAR is implementing and evaluating the integration of a depression management model into HIV care in Malawi. The intervention combines two depression treatment models—algorithm-based medication management and problem-solving therapy—into a single intervention that is offered at two HIV clinics in Lilongwe to patients newly initiating antiretroviral treatment and who have depressive symptoms. The study employs a multiple baseline design to compare depression response, retention in HIV care, and viral suppression among patients receiving the combined intervention compared to usual care.


The impact
This study will provide critical evidence on the feasibility, effectiveness, and cost-effectiveness of an integrated depression treatment model for improving retention in and adherence to HIV care. Such evidence has implications not only for the applicability of the model in Malawi but for other countries in sub-Saharan Africa as well.