Mental Health
Common mental disorder improvement after a 6-week talk-therapy intervention among people with HIV on methadone maintenance treatment in Hanoi, Vietnam Teresa R Filipowicz* Teresa R Filipowicz Ha V Tran Ha T T Nong Thuy T T Tran Kelsey R Landrum Sydney E Browder Brian W Pence Giang M Le Ruth Verhey Bradley N Gaynes
Background
Common mental disorders (CMDs), such as depression, anxiety, and stress, frequently affect people with HIV (PWH) who inject drugs in Vietnam, a country with limited mental health professionals. Task shifting mental health care to lay counselors is a response to resource constraints, but it is unclear if this economical option is as effective as mental health care from professional counselors.
Methods
VITAL was a pilot randomized controlled trial to adapt a CMD intervention (Friendship Bench [FB]) for PWH on methadone treatment in Hanoi, Vietnam. Participants were individually randomized to 1 of 3 arms: FB delivered by professional (n=25) or lay counselors (n=25) in 6 weekly sessions, or standard care (n=25). This analysis compares symptom response over the 6 sessions in the two FB arms. We defined CMD symptom response as a mean reduction of ≥50% across all CMD symptom domains elevated at baseline for ≥2 consecutive weeks. We estimated the mean difference between arms in average weekly CMD symptom change and time to CMD response via a generalized linear model and a Kaplan Meier estimator, respectively. We compared differences in survival curves using a log-rank test (α=0.05).
Results
All lay counseled and 96% of professionally counseled participants were male with a mean age of 45 and 44 years, respectively. Ten of 25(40%) of professionally counseled participants experienced CMD response compared to 7 of 25(28%) lay counseled participants (proportion difference: 12%(-14, 28). Professionally counseled participants had a mean -30.0 CMD symptom improvement compared to -26.5 for lay counseled participants (mean difference -3.5[-23.9, 16.8]). The survival curves did not differ significantly (p-value = 0.63).
Conclusion
There is no meaningful difference in CMD response between professionally counseled versus lay counseled participants in this pilot study. Additional, larger-scale trials are needed to explore if CMD response from talk therapy differs by counselor type.
