Collaborative Care for the Detection and Management of Depression Among Adults Receiving Antiretroviral Therapy in South Africa

NCT ID: NCT02407691

Last Updated: 2023-11-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2002 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-30

Study Completion Date

2018-01-31

Brief Summary

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With increasing access to antiretroviral therapy (ART) in South Africa, HIV has transitioned from a terminal illness to a long-term condition. It is likely to be accompanied by higher levels of disability and other chronic non-communicable diseases, resulting from the HIV itself, as well as adverse effects of medication. This requires an expansion of the purview of HIV care beyond direct HIV clinical care to also include a more comprehensive and integrated package of treatment and care for physical and mental conditions and their consequences. COBALT is a pragmatic cluster randomized controlled trial (RCT) in public sector primary care clinics in the North West Province of SA. It will assess mental health and HIV outcomes for depressed adults receiving ART by measuring the real-world effectiveness of a facility-based stepped care intervention combining depression case detection by non-physician clinicians with group counselling intervention delivered by lay-health workers.

Detailed Description

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Conditions

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HIV/AIDS Depression Chronic Diseases of Lifestyle

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Primary Care 101 Enhanced guideline

Primary Care 101 guideline with enhanced mental health

Group Type EXPERIMENTAL

Primary care 101 plus mental health

Intervention Type OTHER

A facility-based stepped care intervention combining depression case detection by non-physician clinicians with group counselling intervention delivered by lay-health workers.

Standard of care

Primary Care 101 standard version guideline

Group Type ACTIVE_COMPARATOR

Standard Primary Care 101

Intervention Type OTHER

Standard Primary Care 101 guideline with standard training

Interventions

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Primary care 101 plus mental health

A facility-based stepped care intervention combining depression case detection by non-physician clinicians with group counselling intervention delivered by lay-health workers.

Intervention Type OTHER

Standard Primary Care 101

Standard Primary Care 101 guideline with standard training

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Clinics:

1\) 40 nurse-led primary care clinics providing ART in the Dr Kenneth Kaunda and Bojonala districts of the North West Province, South Africa

Patients:

1. Age ≥ 18 years and
2. Receiving ART at the time of enrollment and
3. Depressive symptoms, as indicated by a total score of 9 or more on the PHQ-9 and
4. Planning to reside in the area for the next year and
5. Capable of actively engaging in an interviewer-administered questionnaire at the time of recruitment, six and twelve months later and
6. Written consent to participate in the study

Exclusion Criteria

Clinics:

1\) Clinics which participate in the formative research and piloting of the intervention

Patients:
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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King's College London

OTHER

Sponsor Role collaborator

University of KwaZulu

OTHER

Sponsor Role collaborator

University of Cape Town

OTHER

Sponsor Role lead

Responsible Party

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Babalwa Zani

www.knowledgetranslation.co.za

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lara Fairall, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Cape Town, Cape Town, South Africa

Inge Pitersen, PhD

Role: PRINCIPAL_INVESTIGATOR

University of KwaZulu-Natal, Durban, South Africa

Graham Thornicroft, PhD

Role: PRINCIPAL_INVESTIGATOR

King's College London

Locations

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Dr Kenneth Kaunda District

Klerksdorp, North West, South Africa

Site Status

Bojanala District

Rustenburg, North West, South Africa

Site Status

Countries

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South Africa

References

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Zani B, Fairall L, Petersen I, Folb N, Bhana A, Thornicroft G, Hanass-Hancock J, Selohilwe O, Petrus R, Carmona S, Lombard C, Lund C, Levitt N, Bachmann M. Sociodemographic and health-related factors associated with viral load non-suppression and body mass index in adults with depression symptoms receiving antiretroviral therapy in South African primary care: secondary analysis of randomised trial data. medRxiv [Preprint]. 2025 Aug 5:2025.08.01.25332690. doi: 10.1101/2025.08.01.25332690.

Reference Type DERIVED
PMID: 40799963 (View on PubMed)

Zani B, Fairall L, Petersen I, Folb N, Bhana A, Hanass-Hancock J, Selohilwe O, Petrus R, Georgeu-Pepper D, Mntambo N, Kathree T, Carmona S, Lombard C, Lund C, Levitt N, Bachmann M, Thornicroft G. Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial. J Affect Disord. 2025 Feb 1;370:499-510. doi: 10.1016/j.jad.2024.10.061. Epub 2024 Oct 21.

Reference Type DERIVED
PMID: 39442695 (View on PubMed)

Fairall L, Petersen I, Zani B, Folb N, Georgeu-Pepper D, Selohilwe O, Petrus R, Mntambo N, Bhana A, Lombard C, Bachmann M, Lund C, Hanass-Hancock J, Chisholm D, McCrone P, Carmona S, Gaziano T, Levitt N, Kathree T, Thornicroft G; CobALT research team. Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial. Trials. 2018 Mar 22;19(1):193. doi: 10.1186/s13063-018-2517-7.

Reference Type DERIVED
PMID: 29566739 (View on PubMed)

Related Links

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Other Identifiers

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1R01MH100470-01

Identifier Type: NIH

Identifier Source: org_study_id

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