A feasibility study of behavioural activation therapy for HIVpositive women

撒哈拉以南非洲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。抑郁症在这些女性中非常普遍，高达40%的筛查结果高于抑郁症的阈值2,3。围产期抑郁症与抗逆转录病毒治疗依从性差、就诊率低、自杀意念和母乳喂养率低有关。主要关注的是对胎儿结局、儿童生长和认知发育的负面影响的证据。改善母亲和婴儿的健康状况需要有效治疗艾滋病毒和围产期抑郁症。虽然抑郁症的治疗使艾滋病治疗的依从性提高了80% 5，但目前还没有确定的有效治疗艾滋病母亲围产期抑郁症的方法。本研究的目的是开发和测试针对艾滋病毒阳性妇女围产期抑郁的六期干预的可行性和可接受性。干预将利用行为激活（BA），这已被证明在高收入环境中与认知行为疗法（CBT）一样有效。在资源不足的环境中，特别是由培训有限的非专业卫生工作者提供，BA比CBT简单得多。需要进行早期研究，以制定、标准化和试点BA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，并跟踪她们到产后3个月。主要研究的结果将包括：母亲抑郁、儿童情感和认知发育和成长、坚持抗逆转录病毒治疗、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，该中心是艾滋病毒流行率很高的南非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.