Exploring depression treatment in people living with HIV/AIDS in Ethiopia

Summary

Depression that is associated with other health conditions such as HIV/AIDS is a public health concern. Biksegn’s work examines the role of evidence-based psychological interventions to manage depression. His research evaluates the acceptability and feasibility of culturally-adapted group interpersonal therapy for depression for people living with HIV/AIDS in Ethiopia.

How my personal lived experience informed my research pathway

I was born and raised in the rural Amhara province in Ethiopia. The community that I grew up in is shaped by traditions that promote socialisation in both joyful and difficult times. Every adult is expected to participate in weekly and monthly social gatherings known as “Equb”, “Edir” and “Mahber”, the purpose of which is to reinforce group socialisation and establish social support mechanisms.

The Amhara people are best known for their dining culture in which households and any visitors always share the same dining table and the same meal from the same plate (Mesob). However, people with mental health conditions, locally known as “Ebid”, are not invited to be part of this tradition. I can remember as a child when such people were excluded from social participation, for example their ideas were unheard and considered useless. They were relegated to dine separately and to eat leftovers. It was not clear to me why these people were treated differently, why they dressed, cleaned and communicated differently. These childhood memories inspired me to learn about the mind and later drove me to mental health research.  

Depression and HIV/AIDS co-morbidity: a major public health concern

The World Health Organization (WHO) reports that more than 264 million people of all ages are suffering from depression globally. Depression is two to three times more prevalent in people living with HIV/AIDS than in the general population, due to the vulnerability of HIV-related psychosocial adversities such as social exclusion, physical sickness, unemployment and poverty. Co-morbid depression that is associated with other conditions - affects engagement with HIV treatment, increases stigma associated with HIV/AIDS and exacerbates functional disability. This can lead to HIV treatment failure and increase the risk of HIV transmission to other people.

The need for research to inform mental health care

In Low- and Middle-Income Countries (LMICs) more than 90% of people with mental disorders do not receive basic treatment. Factors contributing to this mental health gap are complex and include insufficient mental health financing and a shortage of trained healthcare providers. AMARI seeks to address these shortcomings in Africa by equipping mental health researchers to develop innovative interventions, particularly for integration of screening and treatment for Mental, Neurological and Substance use disorders into existing programmes such as HIV/AIDS and maternal and child health. AMARI provides advanced mental health research, intervention and implementation training in Ethiopia, Malawi, South Africa and Zimbabwe.    

Psychological interventions and access to basic mental health services

Psychological interventions played significant role in managing different mental health conditions. Cultural adaptation of psychological interventions believed to maximize their acceptable, feasible and effectiveness in LMICs. For my project, “Depression and HIV/AIDS: adapting and piloting group interpersonal therapy for treatment of depression for people living with HIV/AIDS in Northwest Ethiopia”, our research team systematically explored psychological interventions that have been tested on people living with HIV/AIDS in LMICs. We adapted group interpersonal therapy and piloted it among randomly selected depressed people living with HIV/AIDS. The intervention was administered by trained peer-counsellors and was found to be acceptable and feasible. We chose to administer interpersonal therapy in a group format based on supporting evidence from our findings, and chose the Amhara people as our study group based on our understanding of their communal culture and because more than 90% of people in the Amhara province in Northwest Ethiopia are from the Amhara ethnic group, who have a tradition of group society and problem-solving.

Adapting group interpersonal therapy

Psychological interventions including group interpersonal therapy are highly culture-sensitive; therefore, systematic and participatory cultural adaptation is necessary to enhance the acceptability and feasibility of intervention, especially in the diverse cultures of Africa. Positive findings could encourage mental health researchers to investigate the effectiveness of peer-administered group interpersonal therapy for depression in people living with HIV/AIDS in Ethiopia.  Our study leads us to believe that co-morbid depression can be managed using lay counsellor-administered psychological interventions such as interpersonal therapy in LMICs following proper cultural adaptation. This overcomes the shortage of trained human resources to provide mental health interventions in low-income settings.

About Biksegn Asrat

Biksegn Asrat is an Ethiopian Mental Health practitioner and a PhD fellow in Public Mental Health at the University of Cape Town in South Africa. He is a Fellow of the African Mental Health Research Initiative (AMARI) one of the eleven Developing Excellence, Leadership, and Training in Science in Africa (DELTAS Africa) programmes, which fund African scientists to amplify the development of world-class research and scientific leadership on the continent while strengthening African institutions. DELTAS Africa is implemented through the Alliance for Accelerating Excellence in Science in Africa (AESA), a funding, agenda-setting, programme management initiative of the African Academy of Sciences (AAS), the African Union Development Agency (AUDA-NEPAD), founding and funding global partners, and through a resolution of the summit of African Union Heads of Governments. DELTAS Africa is supported by Wellcome and the United Kingdom Foreign, Commonwealth and Development Office (FCDO, formerly DFID).