Guided internet-based intervention for people with HIV and depressive symptoms: a randomised controlled trial in the Netherlands

Background Many people living with HIV have depressive symptoms, but some individuals do not receive adequate treatment. We developed an online self-help intervention for people with HIV with depressive symptoms on the basis of previous research. The aim of this study was to investigate the effectiveness of the intervention on depressive symptoms in individuals with HIV. Methods In this randomised controlled trial, participants recruited from 23 HIV treatment centres in the Netherlands were eligible if they were aged 18 years and older, had been diagnosed with HIV at least 6 months before the study, and had mild to moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4 and <20). Individuals also had to speak English or Dutch and have internet access and an email address. Participants were randomly assigned (1: 1) to an internet-based intervention (Living positive with HIV) or an attention-only waiting-list control condition. Randomisation was done using random number tables, with permuted blocks of 12, stratified by treatment centre and sex. Participants, researchers, and coaches were not masked to group allocation. The primary outcome was depressive symptoms assessed with the PHQ-9 and the Center for Epidemiologic Studies Depression Scale (CES-D) at pretest, 8 weeks after baseline, and 3 months after completion of the intervention or control condition (post-test 2). The primary analysis was done by intention to treat. Between group effect size was assessed with Cohen's d. This trial is registered with the Netherlands Trial Registry, number NTR5407. Findings Between Feb 1, and Dec 31, 2015, we randomly assigned 188 participants to the intervention group (n=97) or the control group (n=91). Mean pretest PHQ-9 score was 11.74 (SD 2.49) in the intervention group and 11.11 (2.37) in the control group; at the post-test visits it was 6.73 (3.00) and 6.62 (3.03) in the intervention group and 8.60 (3.12) and 8.06 (3.17) in the control group. Mean pretest CES-D score was 24.91 (5.93) in the intervention group and 22.94 (6.48) in the control group; at the post-test visits it was 13.94 (6.39) and 15.71 (6.39) in the intervention group and 19.09 (7.05) and 18.43 (7.05) in the control group. The reduction in depressive symptoms was significantly larger in the intervention group than in the control group (d=-0.56 [95% CI -0.85 to -0.27] for PHQ-9 and -0.72 [-1.02 to -0.42] for CES-D at post-test 1; -0.46 [-0.75 to -0.17] for PHQ-9 and -0.47 [-0.76 to -0.18] for CES-D at post-test 2). No adverse events were reported. Interpretation This guided internet-based intervention might be effective for the treatment of depressive symptoms. Future research should focus on the effectiveness of online psychological interventions for people with HIV who have mental health problems in low-income and middle-income countries. Copyright (c) 2018 Elsevier Ltd. All rights reserved.