The cluster-randomized controlled trial, conducted across 40 public HIV clinics in central and southwestern Uganda, evaluated the HIV+D intervention: a collaborative stepped-care model coordinated by trained lay counsellors and comprising psychoeducation, behavioural activation, antidepressant medication, and referral to a mental health worker when needed. Adults receiving HIV+D experienced substantially greater reductions in depression severity than those receiving enhanced usual HIV care.

At three months, participants in the HIV+D group had markedly lower depression scores, with benefits sustained at 12 months. The intervention was especially effective for individuals with severe depression at baseline.

Depression affects an estimated 15% of people living with HIV in Africa and is associated with poorer quality of life, reduced treatment adherence, faster disease progression, and increased mortality. Despite this, mental health services are rarely integrated into routine HIV care.

“This study shows that effective and safe depression care can be delivered directly within HIV clinics using a task-sharing approach,” said Professor Eugene Kinyanda, lead author and Head of the Mental Health Focus Area at the MRC/UVRI & LSHTM Uganda Research Unit. “In this model, non-specialist health workers provide first-line care, HIV clinicians prescribe antidepressant medication, and scarce mental health specialists focus on patients who do not respond to treatment or who present with psychiatric emergencies. Importantly, this approach is well aligned with the realities of Uganda’s public health system and similar settings.”

More than 90% of participants who required behavioural activation received the recommended number of sessions, demonstrating feasibility within routine services.

“The strength of this intervention lies not only in its effectiveness but in its practicality,” said Dr Leticia Kyohangirwe, co-author and study coordinator. “It shows that meaningful mental health care can be delivered now within existing HIV systems.”

The findings support calls by WHO and UNAIDS to integrate mental health into HIV services and align with Uganda’s National HIV and AIDS Strategic Plan, which prioritises management of co-morbidities within HIV care.

“This study moves the conversation from why mental health should be integrated into HIV care to how it can be done,”said Professor Moffat Nyirenda, Director of the MRC/UVRI & LSHTM Uganda Research Unit. “It offers a practical roadmap for closing one of the most persistent gaps in HIV care.”

The authors conclude that the HIV+D model offers a scalable approach for improving mental health outcomes among people living with HIV and could be adapted across sub-Saharan Africa and other low-resource settings.

The study, “Assessing the effectiveness of a depression-integrated model in adult HIV care in Uganda (the HIV+D trial),” is published open access in The Lancet HIV and was funded by the Wellcome Trust.

ENDS

Notes to editors

• Journal: The Lancet HIV
• DOI: 10.1016/S2352-3018(25)00232-2
• Study design: Cluster-randomised controlled trial (40 public HIV clinics)
• Participants: 1,115 adults living with HIV and depression
• Trial registration: ISRCTN86760765
• Publication Link: Assessing the effectiveness of a depression-integrated model in adult HIV care in Uganda (the HIV+D trial): a cluster-randomised controlled trial
• Possible angle: Ugandan researchers show how to close mental health gap in HIV care
   

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MRC/UVRI and LSHTM Uganda Research Unit
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