A feasibility study of behavioural activation therapy for HIVpositive women

撒哈拉以南非洲(SSA)部分地区孕妇的艾滋病毒感染率非常高，例如，南非产前诊所的艾滋病毒感染率超过30%。许多人在怀孕期间接受诊断，作为预防母婴传播筛查的一部分。抑郁在这些妇女中非常普遍，高达40%的筛查高于抑郁的门槛2，3。围产期抑郁与对抗逆转录病毒治疗(ART)4，5的依从性差，临床就诊率低，自杀意念6和母乳喂养率低7有关。主要关注的是对胎儿结局、儿童成长和认知发展产生负面影响的证据7。改善母婴健康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艾滋病毒治疗的依从性，但在艾滋病毒携带者母亲的SSA中，还没有建立有效的围产期抑郁症治疗方法。这项研究的目的是开发和测试针对HIV阳性妇女围产期抑郁的六次干预的可行性和可接受性。这项干预将利用行为激活(BA)，它已被证明在高收入环境下与认知行为疗法(CBT)一样有效。BA的提供比CBT简单得多，特别是对于在资源不足的情况下培训有限的非专科卫生工作者。需要进行这项早期研究，以开发、标准化和试点广管局的干预措施，并测试其可行性。这项研究将为70名孕妇提供治疗，并跟踪她们出生后3个月的情况。主要研究的结果将包括：产妇抑郁、儿童情绪和认知发展和成长、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，该中心是南非的一个大型人口监测点，艾滋病毒流行率很高。

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.