- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03892915
Maternal Depression Treatment in HIV (M-DEPTH)
November 14, 2023 updated by: RAND
Depression Care to Improve Adherence to Prevention of Mother-to-Child-Transmission (PMTCT) Care Continuum & Pregnancy Outcomes
Cluster randomized controlled trial to compare the effects of task-shifted, evidence-based depression care vs. usual care on adherence to each step of the prevention of mother-to-child-transmission (PMTCT) care cascade at 8 antenatal care (ANC) clinics in Uganda.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Detailed Description
This study is a cluster randomized controlled trial (RCT) to compare the effects of task-shifted, evidence-based depression care vs. usual care on adherence to each step of the PMTCT care cascade at 8 ANC clinics in Uganda.
At 4 experimental sites, task-shifted, depression care will include (1) depression screening and psychoeducation, (2) depression diagnosis, and (3) provision of evidence-based problem solving therapy (PST), or antidepressant therapy (ADT) for those with severe and refractory depression (or who decline PST), to be implemented by trained peer mothers and midwife nurses, respectively.
The 4 control sites will use usual care services for managing depression, which consist of referrals to a mental health specialist and access to the Family Support Group program (comprehensive, monthly multi-session psychosocial program to enhance pregnancy management and PMTCT adherence).
At each site, 50 HIV-positive newly pregnant women (total n=400) who screen positive for potential depression will be enrolled and followed until 18-months post-delivery to assess how depression and depression alleviation relate to primary (adherence to each component of the PMTCT care continuum, maternal virologic suppression) and secondary (infant HIV status; post-natal maternal and child health outcomes) outcomes, as well as processes of depression care (treatment uptake and depression alleviation among clinically depressed patients).
A cost-effectiveness analysis will be used to compare the two study arms.
Study Type
Interventional
Enrollment (Actual)
391
Phase
- Phase 2
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
-
Kampala, Uganda
- Makerere University
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- detection of pregnancy through 24 weeks gestation (to ensure at least 12 weeks remaining antenatal period for assessing adherence to all stages of PMTCT care cascade)
- HIV-positive
- positive screen for potential depression on 2-item Patient Health Questionnaire (PHQ-2>0)
- on ART for at least 4 weeks
Exclusion Criteria:
- unstable health (about to start ART or on ART < 4 weeks; active, untreated opportunistic infection)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Depression Care
Task-shifted depression care, consisting of (1) depression screening and psychoeducation, (2) depression diagnosis, and (3) evidence-based problem solving therapy (PST) or antidepressant therapy (ADT; for those with severe and refractory depression, or who decline PST), to be implemented by trained peer mothers and midwife nurses in addition to usual care.
|
We will use a stepped care approach to depression treatment.
Participants with clinical depression (defined as PHQ-9>9) will be offered either Problem Solving Therapy (PST) or Antidepressant Therapy (ADT), but those with moderate to moderately severe depression will be recommended PST, while those with severe depression will be recommended ADT.
Participants with subthreshold depressive symptoms (PHQ-9: 5-9) will receive depression psychoeducation and continued depressive monitoring.
|
No Intervention: Usual care
Usual care processes for treating depression consist of referrals to mental health specialists and access to the Family Support Group program (a nation wide Ministry of Health program for HIV+ women at public ANC clinics, consisting of monthly sessions designed to provide psychosocial support and education to promote pregnancy management and PMTCT adherence).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of maternal HIV viral suppression
Time Frame: One month post pregnancy
|
Proportion of participants who achieve undetectable HIV viral load as measured by blood assay
|
One month post pregnancy
|
Mean maternal antiretroviral (ART) adherence
Time Frame: From study enrollment to one-month post pregnancy
|
Group mean proportion of prescribed ART doses taken as measured by pharmacy refill data
|
From study enrollment to one-month post pregnancy
|
Rate of prevention of mother-to-child-transmission (PMTCT) care retention
Time Frame: through study completion, an average of 48 weeks
|
Proportion of participants who continue to attend antenatal care (ANC) visits as measured by chart abstraction
|
through study completion, an average of 48 weeks
|
Rate of delivery in health facility
Time Frame: one month post pregnancy
|
Proportion of participants who delivery their baby of in a health facility as measured by chart abstraction
|
one month post pregnancy
|
Rate of infant use of ART
Time Frame: First 6 weeks of life
|
Proportion of delivered infants who receive ART as measured by chart abstraction
|
First 6 weeks of life
|
Rate of universal infant feeding
Time Frame: First 6 months of life
|
Proportion of delivered infants who receive uniform feeding method (breastfeeding or formula) as documented by self-report
|
First 6 months of life
|
Rate of complete infant HIV testing
Time Frame: 18 months after birth
|
Proportion of delivered infants who are tested for HIV at all specified intervals, as measured by chart abstraction
|
18 months after birth
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Child HIV status
Time Frame: 18 months after birth
|
HIV status of child
|
18 months after birth
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Glenn Wagner, PhD, RAND
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Wagner GJ, McBain RK, Akena D, Ngo V, Nakigudde J, Nakku J, Chemusto H, Beyeza-Kashesya J, Gwokyalya V, Faherty LJ, Kyohangirwe L, Nabitaka LK, Lukwata H, Linnemayr S, Ghosh-Dastidar B, Businge J, Mukasa B, Wanyenze RK. Maternal depression treatment in HIV (M-DEPTH): Study protocol for a cluster randomized controlled trial. Medicine (Baltimore). 2019 Jul;98(27):e16329. doi: 10.1097/MD.0000000000016329.
- Wagner GJ, Gwokyalya V, Akena D, Nakigudde J, McBain R, Faherty L, Ngo V, Nakku J, Kyohangirwe L, Banegura A, Beyeza-Kashesya J, Wanyenze RK. Stressors and Maladaptive Coping Mechanisms Associated with Elevated Perinatal Depressive Symptoms and Suicidality Among Women Living with HIV in Uganda. Int J Behav Med. 2023 Oct;30(5):743-752. doi: 10.1007/s12529-022-10124-3. Epub 2022 Sep 20.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
July 8, 2019
Primary Completion (Actual)
August 31, 2023
Study Completion (Estimated)
May 31, 2024
Study Registration Dates
First Submitted
March 21, 2019
First Submitted That Met QC Criteria
March 25, 2019
First Posted (Actual)
March 27, 2019
Study Record Updates
Last Update Posted (Estimated)
November 16, 2023
Last Update Submitted That Met QC Criteria
November 14, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2017-1041
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
We will make the data publicly available in the form of an electronic database for researchers who successfully complete a registration process.
Data will be de-identified.
We will provide documentation in the form of a codebook in which each variable name and response options are defined.
Users must agree to the conditions of use governing access to the public release data.
Users must submit brief proposals regarding intended use of the data; the study team will determine the scientific soundness of the proposal, as well as whether adequate data protections in place, as part of the decision for the researcher to be able to access the public use dataset.
IPD Sharing Time Frame
Following publication of the main paper(s) for this study and the grant end-date.
IPD Sharing Access Criteria
Users must submit brief proposals regarding intended use of the data; the study team will determine the scientific soundness of the proposal, as well as whether adequate data protections in place, as part of the decision for the researcher to be able to access the public use dataset.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Depression
-
ProgenaBiomeRecruitingDepression | Depression, Postpartum | Depression, Anxiety | Depression Moderate | Depression Severe | Clinical Depression | Depression in Remission | Depression, Endogenous | Depression ChronicUnited States
-
Washington University School of MedicineCompletedTreatment Resistant Depression | Late Life Depression | Geriatric Depression | Refractory Depression | Therapy-Resistant DepressionUnited States, Canada
-
Kintsugi Mindful Wellness, Inc.Sonar Strategies; Vituity PsychiatryRecruitingDepression | Depression Moderate | Depression Severe | Depression MildUnited States
-
University of California, San FranciscoRecruitingDepression Moderate | Depression Mild | Depression, TeenUnited States
-
University GhentUniversiteit Antwerpen; Janssen-Cilag Ltd.RecruitingDepression Moderate | Depression Severe | Depression MildBelgium
-
Baylor College of MedicineUniversity of TexasRecruitingDepression | Depression Moderate | Depression Severe | Suicide and Self-harm | Depression in Adolescence | Depression MildUnited States
-
University of Cape TownNational Institute of Mental Health (NIMH)CompletedPostpartum Depression | Clinical Depression | Moderate DepressionSouth Africa
-
Washington University School of MedicinePatient-Centered Outcomes Research Institute; National Institute of Mental...CompletedMajor Depressive Disorder | Treatment Resistant Depression | Treatment-Refractory Depression | Late Life Depression | Geriatric DepressionUnited States, Canada
-
Northern Illinois UniversityUniversity Autonoma de Santo DomingoTerminatedDepression Moderate | Depression MildUnited States, Dominican Republic
-
Gerbera Therapeutics, Inc.Not yet recruitingPostpartum Depression | Depression, Postpartum | Postnatal Depression | Post-partum Depression | Post-Natal DepressionUnited States
Clinical Trials on evidence-based depression treatment
-
US Department of Veterans AffairsCompletedSubstance-Related Disorders | Mood DisordersUnited States
-
Judge Baker Children's CenterUniversity of Illinois at Chicago; University of Hawaii; MacArthur FoundationCompleted
-
University of OsloHelse FonnaRecruitingMyalgia | Shoulder Pain | Rotator Cuff Tear or Rupture, Not Specified as Traumatic | Frozen Shoulder | Rotator Cuff Tendinosis | Rotator Cuff Impingement SyndromeNorway
-
Karolinska InstitutetRegion Stockholm; Jane and Dan Olsson Foundation for Scientific PurposesCompletedDomestic Violence | Family Violence | Intimate-partner ViolenceSweden
-
Pontificia Universidad Catolica Madre y MaestraMinisterio de Educación Superior, Ciencia y Tecnología, Dominican RepublicRecruitingDepression | Anxiety Disorders | Emotional Disorder | Somatic DisordersDominican Republic
-
University of MiamiNational Institute of Mental Health (NIMH)CompletedDepression | Anxiety DisordersUnited States
-
Technical University of MunichBayer; Organon; Sanofi-Synthelabo; AOK Bayern; Ratiopharm GmbH; Berlin-Chemie Menarini and other collaboratorsTerminated
-
Universitätsklinikum Hamburg-EppendorfEpilepsy Centre AlsterdorfCompleted
-
Universitätsklinikum Hamburg-EppendorfCompleted
-
University of California, San FranciscoCompletedExperimental Condition TCT | Controlled Condition CGUnited States