Sociodemographic and clinical characteristics of the respondents.

<p>Sociodemographic and clinical characteristics of the respondents.</p

Bivariate analysis of the sociodemographic and clinical characteristics of the respondents.

*<p>denotes p value <0.05 and statistical significance.</p

Multivariable analysis showing associations between major depression, AIDS related stigma and CD4 counts.

*<p>denotes p value <0.05 and statistical significance. Odds ratios adjusted for sex and age.</p

A Structured Protocol Model of Depression Care versus Clinical Acumen: A Cluster Randomized Trial of the Effects on Depression Screening, Diagnostic Evaluation, and Treatment Uptake in Ugandan HIV Clinics

<div><p>Depression is common among people living with HIV, and it has consequences for both HIV prevention and treatment response, yet depression treatment is rarely integrated into HIV care in sub-Saharan Africa, partly due to the paucity of mental health professionals. We conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by medical providers: one that utilized a structured protocol, and one that relied on clinical acumen, in 10 HIV clinics in Uganda. Both models started with routine depression screening of all clients at triage using the 2-item Patient Health Questionnaire (PHQ-2), from which we enrolled 1252 clients (640 at structured protocol clinics, 612 at clinical acumen clinics) who had screened positive over 12 months. We compared the two models on (1) proportion of all client participants, and those clinically depressed (based on survey-administered 9-item PHQ-9>9), who received post-screening evaluation for depression using the PHQ-9; and (2) proportion of clinically depressed who were prescribed antidepressant therapy. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering; patient characteristics, clinic size and time fixed effects were included as covariates. Among all client participants, those in the structured protocol arm were far more likely to have received further evaluation by a medical provider using the PHQ-9 (84% vs. 49%; beta = .33; p = .01). Among the clinically depressed clients (n = 369), the advantage of the structured protocol model over clinical acumen was not statistically significant with regard to PHQ-9 depression evaluation (93% vs. 68%; beta = .21; p = .14) or prescription of antidepressants (69% vs. 58%; beta = .10; p = .50), in part because only 30% of clients who screened positive were clinically depressed. These findings reveal that in both models depression care practices were widely adopted by providers, and depression care reached most depressed clients. The structured protocol model is advantageous for ensuring that positively screened clients receive a depression evaluation, but the two models performed equally well in ensuring the treatment of depressed clients in the context of strong supervision support.</p><p><b><i>Trial Registration</i>:</b> ClinicalTrials.gov <a href="https://www.clinicaltrials.gov/ct2/show/NCT02056106?term=NCT02056106&rank=1" target="_blank">NCT02056106</a></p></div

Proportion of All Participants Administered Depression Diagnostic Evaluation by Month of Enrollment.

<p>Proportion of All Participants Administered Depression Diagnostic Evaluation by Month of Enrollment.</p

Participant Characteristics for the Total Sample and by Study Arm.

<p>SD = standard deviation.</p

MOESM2 of Catatonia in Ugandan children with nodding syndrome and effects of treatment with lorazepam: a pilot study

Additional file 2: Table S1. Consensus case definition for Nodding Syndrome - Uganda, 2012

Multivariate regression analyses comparing structured protocol model of depression care vs. clinical acumen on implementing depression diagnostic evaluations and prescription of antidepressants.

<p>Multivariate regression analyses comparing structured protocol model of depression care vs. clinical acumen on implementing depression diagnostic evaluations and prescription of antidepressants.</p

Proportion of Clinically Depressed Participants Prescribed Antidepressants by Month of Enrollment.

<p>Proportion of Clinically Depressed Participants Prescribed Antidepressants by Month of Enrollment.</p

The CONSORT Flowchart.

<p>The CONSORT Flowchart.</p