Cognitive Behavioural Therapy for Adherence and Depression in the Treatment of Patients on Highly Active Antiretroviral Treatment at Kenyatta National and Mbagathi Hospitals, Kenya

Abstract

Depression is the most common mental illness associated with Human Immunodeficiency Virus (HIV) and is a major predictor of poor adherence to antiretroviral treatment. Cognitive Behavioural Therapy for Adherence and Depression (CBT-AD) has been reported as a psychotherapy intervention that equips patients with skills to enhance medication adherence and reduce depression. This study investigated the effectiveness of CBT-AD among patients on Highly Active Antiretroviral Treatment at Kenyatta National Hospital and Mbagathi Hospital in Kenya. A quasi-experimental design was used, targeting HIV patients with poor adherence. The study was conducted between January 2025 and July 2025, involving 198 participants who were randomly assigned in equal numbers to control and experimental groups. CBT-AD was compared to standard care which was used on the control group as the experimental group was subjected to the intervention. In the course of the study, at mid line, 28.8% of the participants who had severe depression were referred for further treatment at baseline of the study. Beck’s Depression Inventory assessed depression levels while the Morisky Scale for Adherence was used to assess levels of adherence. Besides there was a researcher-administered questionnaire which contained one open ended question which was analyzed thematically to investigate the risk factors for adherence to Highly Active Antiretroviral Treatment. Descriptive and inferential statistics using SPSS version 25 with a statistical significance set at p< 0.05 generated results which were presented in tables and charts. Analyses were conducted for three time-frames: baseline, midline and end line. The findings showed high levels of BDI II depression score (M=25.9, SD=6.7) for experimental group and for the control group (M=24.5, SD=8). The experimental group (M=4.4, SD=1.5) had almost the same low levels of adherence like the control group (M=4.3, SD=1.5) at base line. Socio-demographic characteristics associated with both adherence and depression was not statistically significant. There was a negative correlation between adherence and low adherence to HAART. CBT-AD significantly improved both adherence and reduced depression symptoms among participants in the experimental group compared to the control group (p < 0.001). Adherence in the control group also improved unlike their depression levels. Challenges for adherence as reported verbatim by the participants included: intimate partner violence, alcohol consumption, forgetting, socio-economic reasons, lack of disclosure, level of education, side effects of the medication and pill burden among others. There was no significant relationship between these factors and adherence. These results indicated that CBT-AD is an effective intervention for enhancing adherence and reducing depression among people on HAART. The recommendations from the study included the need to enhance screening for depression and adherence during every visit among those on HAART and to adopt CBT-AD as standard care for improving adherence and reduce depression symptoms. Individualized interventions to be instituted to address patients’ unique challenges that compromise adherence to HAART.