Pilot Testing Into the Feasibility of the Developed Cognitive Behavioral Therapy Intervention

NCT ID: NCT07235852

Last Updated: 2025-11-19

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

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-15

Study Completion Date

2026-05-25

Brief Summary

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This pilot feasibility randomized controlled trial will test a culturally adapted cognitive behavioral therapy (Ca-CBT) intervention for depression and anxiety among people living with HIV (PLHIV) in Peshawar, Pakistan. Fifty participants will be randomized to either receive six sessions of the adapted CBT delivered by trained HIV health workers or treatment as usual (TAU). The study will assess feasibility, acceptability, recruitment and retention rates, and preliminary clinical outcomes, to inform the development of a larger definitive trial.

Detailed Description

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This feasibility pilot trial aims to evaluate the acceptability and feasibility of a culturally adapted cognitive behavioral therapy (Ca-CBT) intervention for PLHIV with comorbid depression or anxiety in Pakistan. The study will be conducted at the Family Care Centre (FCC), Hayatabad Medical Complex, Peshawar, which provides HIV diagnosis, registration, treatment, and adherence counselling.

Fifty eligible participants aged 18-65, living with HIV, and meeting the Hospital Anxiety and Depression Scale (HADS) thresholds will be randomized (1:1) to intervention or treatment as usual. The intervention group will receive six consecutive sessions of Ca-CBT, designed to improve depression, anxiety, adherence to ART, and functionality. Sessions will use culturally relevant materials, metaphors, and self-help tools, tailored for low-literacy populations. Delivery will be by HIV health workers trained and supervised under a cascade model.

Primary feasibility outcomes include recruitment, retention, completion of therapy sessions, fidelity of delivery, and acceptability. Secondary outcomes include changes in depression (HADS), functioning (WHODAS), internalized stigma, ART adherence self-efficacy, health-related quality of life (EQ-5D), and trauma symptoms. Assessments will occur at baseline, 8 weeks (post-intervention), and 12 weeks (follow-up).

The trial uses a randomized, single-blind (assessors) two-arm design. Recruitment will draw from the FCC registry of HIV patients. Sample size justification follows CONSORT guidelines for feasibility trials, with traffic-light progression criteria (stop/amend/go thresholds) for decision-making on a definitive trial.

This study will provide essential data on feasibility, acceptability, and preliminary clinical signals to inform a full-scale RCT evaluating culturally adapted CBT for PLHIV in Pakistan.

Conditions

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HIV Infections Depression Anxiety Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomized in a 1:1 ratio to one of two parallel arms (Ca-CBT vs Treatment as Usual). Randomization will use central, computer-generated permuted blocks (blocks of 4), administered by an independent researcher.
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors
Assessors conducting outcome measurements will be blinded to treatment allocation (single-blind design). Randomization and allocation will be performed centrally by an independent researcher not involved in assessments or intervention delivery. Intervention therapists (HIV health workers) and participants will be aware of allocation due to the behavioral nature of the intervention. To reduce accidental unblinding, assessors will be trained to avoid discussing intervention content with participants and will document any instances where they suspect unblinding. Participant perceptions of allocation will be collected post-study to assess potential unblinding.

Study Groups

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Culturally Adapted Cognitive Behavioral Therapy (Ca-CBT)

Participants randomized to this arm will receive a culturally adapted cognitive behavioral therapy (Ca-CBT) intervention delivered by trained HIV health workers. The therapy will consist of six consecutive sessions, each approximately 45-60 minutes, focusing on reducing depression and anxiety symptoms, improving functionality, adherence to antiretroviral therapy (ART), and problem-solving skills. Intervention materials will include culturally relevant stories, metaphors, and self-help audio/video resources, tailored for low-literacy populations.

Group Type EXPERIMENTAL

Culturally Adapted Cognitive Behavioral Therapy (Ca-CBT)

Intervention Type BEHAVIORAL

A six-session culturally adapted cognitive behavioral therapy (Ca-CBT) intervention designed for people living with HIV (PLHIV) with depression or anxiety. Sessions will last 45-60 minutes each, delivered weekly by trained HIV health workers under professional supervision. The intervention incorporates culturally relevant stories, metaphors, and self-help audio/video materials, tailored for low-literacy populations. The therapy focuses on reducing depression and anxiety, improving functioning, enhancing adherence to antiretroviral therapy (ART), and problem-solving skills.

Treatment as Usual (TAU)

Participants randomized to this arm will continue to receive routine HIV care as per the HIV Control Program guidelines. This includes free ART initiation and continuation, regular medical check-ups, medication refills, and adherence counselling provided at the Family Care Centre (FCC), Hayatabad Medical Complex, Peshawar. No additional psychological intervention will be provided in this arm.

Group Type ACTIVE_COMPARATOR

Treatment as Usual (TAU)

Intervention Type OTHER

Participants will receive routine HIV care as provided at Family Care Centres under the National HIV Control Program. This includes free initiation and continuation of antiretroviral therapy (ART), adherence counselling, regular health check-ups, and medication refills. No additional psychological therapy or behavioral intervention will be provided.

Interventions

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Culturally Adapted Cognitive Behavioral Therapy (Ca-CBT)

A six-session culturally adapted cognitive behavioral therapy (Ca-CBT) intervention designed for people living with HIV (PLHIV) with depression or anxiety. Sessions will last 45-60 minutes each, delivered weekly by trained HIV health workers under professional supervision. The intervention incorporates culturally relevant stories, metaphors, and self-help audio/video materials, tailored for low-literacy populations. The therapy focuses on reducing depression and anxiety, improving functioning, enhancing adherence to antiretroviral therapy (ART), and problem-solving skills.

Intervention Type BEHAVIORAL

Treatment as Usual (TAU)

Participants will receive routine HIV care as provided at Family Care Centres under the National HIV Control Program. This includes free initiation and continuation of antiretroviral therapy (ART), adherence counselling, regular health check-ups, and medication refills. No additional psychological therapy or behavioral intervention will be provided.

Intervention Type OTHER

Other Intervention Names

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Culturally adapted CBT, CaCBT Routine HIV care, Standard care under HIV Control Program

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18-65 years.
* Pakistani nationals and residents.
* Confirmed HIV diagnosis (newly diagnosed or on ART within 1 month of diagnosis, or already on lifelong ART, according to UNAIDS HIV diagnostic standards).
* Meeting criteria for depression and anxiety: HADS subscale score \>8 on both depression and anxiety, and total HADS score \>15.
* HIV patients with comorbid conditions (e.g., Hepatitis, HCV) may be included if HIV is the primary condition.

Exclusion Criteria

* Diagnosis of bipolar disorder, psychosis, or other severe mental illness according to ICD-11 or DSM-5-TR.
* Evidence of learning disability or severe substance use disorder (except nicotine).
* Currently receiving psychotherapy or antidepressant medication within the last 6 months.
* Current suicidality (per WHO mhGAP) or suicide attempt within the last 2 years.
* HIV-associated neurocognitive disorders (HAND) or severe complications of HIV preventing participation, as judged by treating physician.
* Living in the same household as another study participant (to prevent contamination between arms).
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Keele University

OTHER

Sponsor Role collaborator

Hayatabad Medical Complex

OTHER_GOV

Sponsor Role collaborator

Khyber Medical University Peshawar

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Huma Mughal, MPH,PhD*

Role: PRINCIPAL_INVESTIGATOR

Keele University

Prof Monica Magadi, PhD

Role: PRINCIPAL_INVESTIGATOR

Keele University

Dr James Prior, PhD

Role: PRINCIPAL_INVESTIGATOR

Keele University

Prof Saeed Farooq, PhD

Role: PRINCIPAL_INVESTIGATOR

Keele University

Dr Shaista Rasool, PhD

Role: PRINCIPAL_INVESTIGATOR

Khyber Medical University

Dr Mirat Gul, PhD

Role: PRINCIPAL_INVESTIGATOR

Mayo Hospital Lahore

Locations

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Family Care Centre (FCC), Hayatabad Medical Complex

Peshawar, Khyber Pakhtunkhwa, Pakistan

Site Status RECRUITING

Countries

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Pakistan

Central Contacts

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Huma Mughal, MPH, PhD

Role: CONTACT

+44 7496 637532

Dr Mian Mukhtar, MBBS, FCPS, FRCP UK

Role: CONTACT

923005900339

Facility Contacts

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Huma Mughal, PhD*

Role: primary

+44 7496 637532

Dr Mian Mukhtar UL Haq, MBBS, FCPS, FRCP UK

Role: backup

03005900339

References

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Mir F, Mahmood F, Siddiqui AR, Baqi S, Abidi SH, Kazi AM, Nathwani AA, Ladhani A, Qamar FN, Soofi SB, Memon SA, Soomro J, Shaikh SA, Simms V, Khan P, Ferrand RA. HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak. Lancet Infect Dis. 2020 Mar;20(3):362-370. doi: 10.1016/S1473-3099(19)30743-1. Epub 2019 Dec 19.

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Reference Type BACKGROUND
PMID: 23351566 (View on PubMed)

Other Identifiers

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KMU/DIR/CTU/2025/007

Identifier Type: -

Identifier Source: org_study_id

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