A feasibility study of behavioural activation therapy for HIVpositive women

在撒哈拉以南非洲（SSA）的部分地区，艾滋病毒感染率在孕妇中非常高，例如在南非的产前诊所，艾滋病毒感染率超过30%。许多人在怀孕期间接受诊断，作为预防母婴传播（PMTCT）筛查的一部分。抑郁症在这些女性中非常常见，高达40%的筛查高于抑郁症的阈值2，3。围产期抑郁症与抗逆转录病毒治疗（ART）依从性差4，5，低门诊就诊率，自杀意念6和低母乳喂养率7相关。主要关注的是对胎儿结局、儿童生长和认知发育产生负面影响的证据7。改善母亲和婴儿的福祉需要有效治疗艾滋病毒和围产期抑郁症8。虽然抑郁症的治疗提高了对HIV治疗的依从性> 80%5，但在SSA中，对于HIV感染母亲的围产期抑郁症尚无有效的治疗方法。本研究的目的是开发和测试的可行性和可接受性的六届干预针对围产期抑郁症的艾滋病毒阳性妇女。干预将利用行为激活（BA），这已被证明是有效的认知行为疗法（CBT）在高收入环境9。BA比CBT简单得多，尤其是在资源不足的环境中，由非专业卫生工作者进行培训。这项早期研究需要开发、验证和试点BA干预措施，并测试其可行性。该研究将为70名孕妇提供治疗，并随访至产后3个月。主要研究的结果将包括：产妇抑郁症、儿童情感和认知发育和成长、坚持抗逆转录病毒疗法、开始和维持母乳喂养、婴儿艾滋病毒检测和疫苗接种。这项工作将在非洲卫生和人口研究中心进行，该中心是南非艾滋病毒流行率高的一个大型人口监测点。

Rates of HIV are very high amongst pregnant women in parts of sub-Saharan Africa (SSA) with, for example rates of over 30% in antenatal clinics in South Africa1. Many receive their diagnosis during pregnancy as partof screening to prevent mother-to-child transmission (PMTCT). Depression is very common amongst these women, with up to 40% screening above the threshold for depression2, 3. Perinatal depression is associatedwith poor adherence to antiretroviral treatment (ART)4, 5, low clinic attendance, suicidal ideation6 and lowrates of breastfeeding7. Of major concern is the evidence of negative effects on fetal outcomes, children'sgrowth and cognitive development7. Improving the wellbeing of mothers and infants requires effectivetreatment of HIV and perinatal depression8. Although treatment of depression improves adherence to HIVtreatment by >80% 5, there is no established effective treatment for perinatal depression in SSA for motherswith HIV. The aim of this study is to develop and test the feasibility and acceptability of a six-session intervention targeting perinatal depression in HIV-positive women. The intervention will utilise Behavioural Activation (BA), which has been shown to be as effective as Cognitive Behaviour Therapy (CBT) in high-income settings9. BA is much simpler than CBT to deliver, especially by non-specialist health workers withlimited training in under-resourced settings. This early phase study is needed to develop, standardise and pilot the BA intervention and test its feasibility. The study will provide treatment for 70 pregnant women and follow them to 3 months postnatally. The outcomes of the main study will include: maternal depression, child emotional and cognitive development and growth, adherence to ART, initiation and maintenance of breastfeeding, infant HIV testing and vaccinations. This work will be conducted at the Africa Centre for Health and Population Studies, a large demographic surveillance site in South Africa with a high HIV prevalence.