{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:36:09Z","timestamp":1790710569370,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH103770"],"award-info":[{"award-number":["R01MH103770"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["1P30MH116867"],"award-info":[{"award-number":["1P30MH116867"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Major depressive disorder, highly prevalent among people with HIV (PWH) globally, including South Africa, is associated with suboptimal adherence to antiretroviral therapy. Globally, there are insufficient numbers of mental health providers and tested depression treatments. This study's aim was to test task\u2010shared cognitive\u2010behavioural therapy for adherence and depression (CBT\u2010AD) in HIV, delivered by clinic nurses in South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a two\u2010arm randomized controlled effectiveness trial (recruitment: 14 July 2016 to 4 June 2019, last follow 9 June 2020). One\u2010hundred\u2010sixty\u2010one participants with clinical depression and virally uncontrolled HIV were recruited from primary care clinics providing HIV care, in Khayelitsha, South Africa. Arm 1 was task\u2010shared, nurse\u2010delivered CBT\u2010AD; and arm 2 was enhanced treatment as usual (ETAU). Primary outcomes (baseline to 4 months) were blinded Hamilton Depression Rating Scale (HAM\u2010D) scores, and weekly adherence via real\u2010time monitoring (Wisepill). Secondary outcomes were adherence and depression over 4\u2010, 8\u2010 and 12\u2010month follow\u2010ups, proportion of participants with undetectable viremia and continuous CD4 cell counts at 12 months. Additional analyses involved viral load and CD4 over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 4 months, the HAMD scores in the CBT\u2010AD condition improved by an estimated 4.88 points more (CI: \u20137.86, \u20131.87, <jats:italic>p<\/jats:italic> = 0.0016), and for weekly adherence, 1.61 percentage points more per week (CI: 0.64, 2.58, <jats:italic>p<\/jats:italic> = 0.001) than ETAU. Over follow\u2010ups, CBT\u2010AD had an estimated 5.63 lower HAMD scores (CI: \u20137.90, \u20133.36, <jats:italic>p<\/jats:italic> &lt; 0.001) and 23.56 percentage points higher adherence (CI: 10.51, 34.21, <jats:italic>p<\/jats:italic> &lt; 0.001) than ETAU. At 12 months, adjusted models indicated that the odds of having an undetectable viremia was 2.51 greater at 12 months (CI: 1.01, 6.66, <jats:italic>p<\/jats:italic> = 0.047), and 3.54 greater over all of the follow\u2010ups (aOR = 3.54, CI: 1.59, 20.50; <jats:italic>p<\/jats:italic> = 0.038) for those assigned CBT\u2010AD. CD4 was not significantly different between groups at 12 months or over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Task\u2010shared, nurse\u2010delivered, CBT\u2010AD is effective in improving clinical depression, ART adherence and viral load for virally unsuppressed PWH. The strategy of reducing depression to allow patients with self\u2010care components of medical illness to benefit from adherence interventions is one to extend. Implementation science trials and analyses of cost\u2010effectiveness are needed to translate findings into clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: NCT02696824 <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02696824\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02696824<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25823","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T11:52:57Z","timestamp":1635421977000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Treating depression and improving adherence in HIV care with task\u2010shared cognitive behavioural therapy in Khayelitsha, South Africa: a randomized controlled trial"],"prefix":"10.1002","volume":"24","author":[{"given":"Steven A.","family":"Safren","sequence":"first","affiliation":[{"name":"Department of Psychology University of Miami  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conall","family":"O'Cleirigh","sequence":"additional","affiliation":[{"name":"Department of Psychology Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Psychiatry Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena S.","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica F.","family":"Magidson","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Maryland  College Park Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Miami  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra A.","family":"Bainter","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Miami  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Musinguzi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Mbarara University of Science and Technology  Mbarara Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Simoni","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Kagee","sequence":"additional","affiliation":[{"name":"Department of Psychology Stellenbosch University  Stellenbosch South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Joska","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"UNAIDS.South Africa [Internet].2018[cited 2018 Nov 5]. 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