The purpose of this study is to evaluate the effectiveness of the Syndemic-Adapted Medly Uganda (SAMU) in improving mental health care among adults living with HIV and hypertension in Uganda. In sub-Saharan Africa (SSA), there is a high prevalence of depression and anxiety among people living with HIV (PLHIV) as well as alcohol use disorder (AUD). PLHIV who experience depression are less likely to link to HIV care, adhere to antiretroviral therapy, and achieve viral suppression. Building on research conducted to adapt Medly Uganda for mental health using a syndemic framework, this study aims to assess the effectiveness of SAMU on mental health screening and diagnosis. This will be accomplished through a two-arm trial in which 1. participants will be enrolled, screened, re-screened, and assessed for diagnosis and linkage to care for depression, anxiety and AUD and 2. evaluate the factors impacting sustained engagement in the SAMU program, through mixed methods.
All staff will be trained in mental health screening prior to the trial launch, and all clinics will be equipped with health education materials to raise awareness of mental health, self-care and available resources in the clinic and community
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,500
Participants will receive an SMS reminding them to enter a SAMU screening session at a regular basis, based on their initial screening scores. Subsequent screeners will trigger a tailored message based on the participants' inputs.
Kawaala Hospital
Kampala, Uganda
Naguru Hospital
Kampala, Uganda
Nsambya Hospital
Kampala, Uganda
Number of participants diagnosed
Number of participants screened and diagnosed with anxiety and/or depression.
Time frame: up to 18 months
Number of participants linked to care
Number of participants linked to care for mental health, alcohol use disorder, HIV and/or hypertension.
Time frame: up to 18 months
Mean score Alcohol Use Disorders Identification Test- C (AUDIT-C)
3-item alcohol screening tool (abbreviated version of the 10-question AUDIT) that identifies hazardous drinking or active alcohol use disorders. It is scored 0-12. Higher scores indicate a higher likelihood of harmful alcohol consumption.
Time frame: Baseline and 6, 12, 18 months
Mean systolic blood pressure
Mean systolic blood pressure in mmHg
Time frame: Baseline and 6, 12 months
Mean diastolic blood pressure
Mean diastolic blood pressure in mmHg
Time frame: Baseline and 6, 12 months
Number of participants with HIV viral load suppression
HIV viral load suppression defined as having \<200 copies/mL of HIV RNA in the blood
Time frame: Baseline and 6, 12 months
Self-reported medication adherence
Assessed as mean days adherent in the last 7 days
Time frame: Baseline and 6, 12 months
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