The effectiveness of depression management for improving HIV care outcomes in Malawi: protocol for a quasi-experimental study

BMC Public Health. 2019 Jun 26;19(1):827. doi: 10.1186/s12889-019-7132-3.


Background: Depression, prevalent among people living with HIV (PLWH) in Malawi, is associated with negative HIV patient outcomes and likely affects HIV medical management. Despite the high prevalence of depression, its management has not been integrated into HIV care in Malawi or most low-income countries.

Methods: This study employs a pre-post design in two HIV clinics in Lilongwe, Malawi, to evaluate the effect of integrating depression management into routine HIV care on both mental health and HIV outcomes. Using a multiple baseline design, this study is examining mental health and HIV outcome data of adult (≥18 years) patients newly initiating ART who also have depression, comparing those entering care before and after the integration of depression screening and treatment into HIV care. The study is also collecting cost information to estimate the cost-effectiveness of the program in improving rates of depression remission and HIV treatment engagement and success.

Discussion: We anticipate that the study will generate evidence on the effect of depression management on HIV outcomes and the feasibility of integrating depression management into existing HIV care clinics. The results of the study will inform practice and policy decisions on integration of depression management in HIV care clinics in Malawi and related settings, and will help design a next-step strategy to scale-up integration to a larger scale.

Trial registration: ID [ NCT03555669 ]. Retrospectively registered on 13 June 2018.

Keywords: Depression; HIV/AIDS; Implementation science; Integration; Malawi; Mental health; Program evaluation; Retention; Sub-Saharan Africa; Task-shifting.

MeSH terms

  • Adolescent
  • Adult
  • Cost-Benefit Analysis
  • Depression / etiology
  • Depression / therapy*
  • Depressive Disorder / etiology
  • Depressive Disorder / therapy
  • Disease Management*
  • Female
  • HIV
  • HIV Infections / complications
  • HIV Infections / psychology*
  • HIV Infections / therapy
  • Humans
  • Malawi
  • Male
  • Mass Screening
  • Mental Health*
  • Patient Care*
  • Research Design
  • Retrospective Studies

Associated data