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Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial

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Abstract

Background

South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking.

Method

Twenty-three pregnant women with HIV (WWH), ages 18–45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview.

Results

Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β =  − 11.1, t(24) =  − 3.1, p < 0.005, 95% CI [− 18.41, − 3.83], and 3 months, β =  − 13.8, t(24) =  − 3.3, p < 0.005, 95% CI [− 22.50, − 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired.

Conclusion

A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children.

Trial Registration

ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417

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References

  1. Kharsany ABM, Cawood C, Khanyile D, et al. Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey. The Lancet HIV. 2018;5:e427–37.

    Article  Google Scholar 

  2. South African National AIDS Council. 2018 Global AIDS Monitoring Report. 2018. https://sanac.org.za/wp-content/uploads/2019/08/Global-AIDS-Report-2018.pdf. Accessed 1 Sept 2021.

  3. South Africa National Department of Health. The 2015 National Antenatal Sentinel HIV & Syphilis Survey. 2017.

  4. UNAIDS. Global HIV & AIDS Statistics — 2019 Fact Sheet. 2019. https://www.unaids.org/en/resources/fact-sheet. Accessed 1 Sept 2021.

  5. Ramoshaba R, Sithole SL. Knowledge and awareness of MTCT and PMTCT post-natal follow-up services among HIV infected mothers in the Mankweng region. South Africa TOAIDJ. 2017;11:36–44.

    Google Scholar 

  6. Kingston D, Tough S, Whitfield H. Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev. 2012;43:683–714.

    Article  Google Scholar 

  7. Rogers A, Obst S, Teague SJ, et al. Association between maternal perinatal depression and anxiety and child and adolescent development: a meta-analysis. JAMA Pediatr. 2020;174:1082.

    Article  Google Scholar 

  8. Brittain K, Myer L, Koen N, et al. Risk factors for antenatal depression and associations with infant birth outcomes: results from a South African birth cohort study. Paediatr Perinat Epidemiol. 2015;29:505–14.

    Article  Google Scholar 

  9. van Heyningen T, Myer L, Onah M, et al. Antenatal depression and adversity in urban South Africa. J Affect Disord. 2016;203:121–9.

    Article  Google Scholar 

  10. Rochat TJ, Tomlinson M, Bärnighausen T, et al. The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord. 2011;135:362–73.

    Article  Google Scholar 

  11. Manikkam L, Burns JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012;102:940.

    Article  Google Scholar 

  12. Zhu Q-Y, Huang D-S, Lv J-D, et al. Prevalence of perinatal depression among HIV-positive women: a systematic review and meta-analysis. BMC Psychiatry. 2019;19:330.

    Article  Google Scholar 

  13. Buchberg MK, Fletcher FE, Vidrine DJ, et al. A mixed-methods approach to understanding barriers to postpartum retention in care among low-income, HIV-infected women. AIDS Patient Care STDS. 2015;29:126–32.

    Article  Google Scholar 

  14. Sheth SS, Coleman J, Cannon T, et al. Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV. AIDS Care. 2015;27:350–4.

    Article  Google Scholar 

  15. Osler M, Hilderbrand K, Goemaere E, et al. The continuing burden of advanced HIV disease over 10 years of increasing antiretroviral therapy coverage in South Africa. Clin Infect Dis. 2018;66:S118–25.

    Article  Google Scholar 

  16. Chilongozi D, Wang L, Brown L, et al. Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania. Pediatr Infect Dis J. 2008;27:808–14.

    Article  Google Scholar 

  17. Peltzer K, Weiss SM, Soni M, et al. A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa. AIDS Res Ther. 2017;14:61.

    Article  Google Scholar 

  18. Sha BE, Tierney C, Cohn SE, et al. Postpartum viral load rebound in HIV-1-infected women treated with highly active antiretroviral therapy: AIDS Clinical Trials Group Protocol A5150. HIV Clin Trials. 2011;12:9–23.

    Article  Google Scholar 

  19. Kuhn L, Kasonde P, Sinkala M, et al. Does severity of HIV disease in HIV-infected mothers affect mortality and morbidity among their uninfected infants? Clin Infect Dis. 2005;41:1654–61.

    Article  Google Scholar 

  20. Ashaba S, Kaida A, Coleman JN, et al. Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda. PLoS One. 2017;12:e0176256.

  21. Choi KW, Smit JA, Coleman JN, et al. Mapping a syndemic of psychosocial risks during pregnancy using network analysis. IntJ Behav Med. 2019;26:207–16.

    Article  Google Scholar 

  22. Psaros C, Remmert JE, Bangsberg DR, et al. Adherence to HIV care after pregnancy among women in sub-Saharan Africa: falling off the cliff of the treatment cascade. Curr HIV/AIDS Rep. 2015;12:1–5.

    Article  Google Scholar 

  23. Brittain K, Mellins CA, Phillips T, et al. Social support, stigma and antenatal depression among HIV-infected pregnant women in South Africa. AIDS Behav. 2017;21:274–82.

    Article  Google Scholar 

  24. Psaros C, Smit JA, Mosery N, et al. PMTCT adherence in pregnant South African women: the role of depression, social support, stigma, and structural barriers to care. Ann Behav Med. 2020;54:626–36.

    Article  Google Scholar 

  25. Peltzer K, Ramlagan S. Perceived stigma among patients receiving antiretroviral therapy: a prospective study in KwaZulu-Natal. South Africa AIDS Care. 2011;23:60–8.

    Article  Google Scholar 

  26. Hodgson I, Plummer ML, Konopka SN, et al. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS One. 2014;9:e111421.

  27. Turan JM, Nyblade L. HIV-related stigma as a barrier to achievement of global PMTCT and maternal health goals: a review of the evidence. AIDS Behav. 2013;17:2528–39.

    Article  Google Scholar 

  28. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18588.

    Article  Google Scholar 

  29. Onono M, Owuor K, Turan J, et al. The role of maternal, health system, and psychosocial factors in prevention of mother-to-child transmission failure in the era of programmatic scale up in western Kenya: a case control study. AIDS Patient Care STDS. 2015;29:204–11.

    Article  Google Scholar 

  30. Futterman D, Shea J, Besser M, et al. Mamekhaya: a pilot study combining a cognitive-behavioral intervention and mentor mothers with PMTCT services in South Africa. AIDS Care. 2010;22:1093–100.

    Article  Google Scholar 

  31. Kapetanovic S, Dass-Brailsford P, Nora D, et al. Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. AIDS Behav. 2014;18:1152–73.

    Article  Google Scholar 

  32. Kaaya SF, Blander J, Antelman G, et al. Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status. AIDS Care. 2013;25:854–62.

    Article  Google Scholar 

  33. Mundell JP, Visser MJ, Makin JD, et al. The impact of structured support groups for pregnant South African women recently diagnosed HIV positive. Women Health. 2011;51:546–65.

    Article  Google Scholar 

  34. Tsai AC, Tomlinson M, Comulada WS, et al. Intimate partner violence and depression symptom severity among South African women during pregnancy and postpartum: population-based prospective cohort study. PLoS Med. 2016;13:e1001943.

  35. Tuthill EL, Pellowski JA, Young SL, et al. Perinatal depression among HIV-infected women in KwaZulu-Natal South Africa: prenatal depression predicts lower rates of exclusive breastfeeding. AIDS Behav. 2017;21:1691–8.

    Article  Google Scholar 

  36. Colvin CJ, Konopka S, Chalker JC, et al. A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS One. 2014;9:e108150.

  37. Geldsetzer P, Yapa HMN, Vaikath M, et al. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care. J Int AIDS Soc. 2016;19:20679.

    Article  Google Scholar 

  38. Dyer TP, Stein JA, Rice E, et al. Predicting depression in mothers with and without HIV: the role of social support and family dynamics. AIDS Behav. 2012;16:2198–208.

    Article  Google Scholar 

  39. Rotheram-Borus MJ, le Roux IM, Tomlinson M, et al. Philani Plus (+): a Mentor Mother community health worker home visiting program to improve maternal and infants’ outcomes. Prev Sci. 2011;12:372–88.

    Article  Google Scholar 

  40. Rotheram-Borus MJ, Richter LM, van Heerden A, et al. A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants. PLoS One 2014;9:e84867.

  41. Kwalombota M. The effect of pregnancy in HIV-infected women. AIDS Care. 2002;14:431–3.

    Article  CAS  Google Scholar 

  42. Bell AC, D’Zurilla TJ. Problem-solving therapy for depression: a meta-analysis. Clin Psychol Rev. 2009;29:348–53.

    Article  Google Scholar 

  43. Nezu A, Maguth Nezu C, D’Zurilla T. Problem-solving therapy: a treatment manual. New York, NY: Springer Publishing Company; 2013.

    Google Scholar 

  44. Safren SA, O’Cleirigh C, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28:1–10.

    Article  Google Scholar 

  45. Lecrubier Y, Sheehan D, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12:224–231.

  46. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–786.

  47. Rochat TJ, Tomlinson M, Newell M-L, et al. Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal Depression Scale (EPDS). Arch Womens Ment Health. 2013;16:401–10.

    Article  Google Scholar 

  48. Lawrie TA, Hofmeyr GJ, De Jager M, et al. Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. S Afr Med J. 1998;88:1340–4.

    CAS  Google Scholar 

  49. Mokwena K, Masike I. The need for universal screening for postnatal depression in South Africa: confirmation from a sub-district in Pretoria. South Africa IJERPH. 2020;17:6980.

    Google Scholar 

  50. Lu M, Safren SA, Skolnik PR, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12:86–94.

    Article  Google Scholar 

  51. AARDEX Corporation. Medication Event Monitoring System (MEMS). Zug, Switzerland: AARDEX Corporation. https://www.aardexgroup.com/solutions/mems-adherence-hardware/. Accessed 1 Sept 2021.

  52. Safren SA, O’Cleirigh CM, Bullis JR, et al. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80:404–15.

    Article  Google Scholar 

  53. Safren SA, Bedoya CA, O’Cleirigh C, et al. Cognitive behavioural therapy for adherence and depression in patients with HIV: a three-arm randomised controlled trial. The Lancet HIV. 2016;3:e529–38.

    Article  Google Scholar 

  54. Safren SA, Hendriksen ES, Desousa N, et al. Use of an on-line pager system to increase adherence to antiretroviral medications. AIDS Care. 2003;15:787–93.

    Article  CAS  Google Scholar 

  55. Holzemer WL, Uys LR, Chirwa ML, et al. Validation of the HIV/AIDS Stigma Instrument—PLWA (HASI-P). AIDS Care. 2007;19:1002–12.

    Article  Google Scholar 

  56. Antelman G, Smith Fawzi MC, Kaaya S, et al. Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dar es Salaam. Tanzania AIDS. 2001;15:1865–74.

    CAS  Google Scholar 

  57. Epino HM, Rich ML, Kaigamba F, et al. Reliability and construct validity of three health-related self-report scales in HIV-positive adults in rural Rwanda. AIDS Care. 2012;24:1576–83.

    Article  Google Scholar 

  58. Dietz P, Bombard J, Mulready-Ward C, et al. Validation of self-reported maternal and infant health indicators in the Pregnancy Risk Assessment Monitoring System. Matern Child Health J. 2014;18:2489–98.

    Article  Google Scholar 

  59. Lilliefors HW. On the Kolmogorov-Smirnov test for normality with mean and variance unknown. J Am Stat Assoc. 1967;62:399–402.

    Article  Google Scholar 

  60. IBM Corp. SPSS. 2012.

  61. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. 2020. http://www.R-project.org/. Accessed 1 Sept 2021.

  62. Pinheiro J, Bates D, DebRoy S, et al. nlme: linear and nonlinear mixed effects models. 2021. https://CRAN.R-project.org/package=nlme. Accessed 1 Sept 2021.

  63. Glaser BG, Strauss AL, Strutzel E. The discovery of grounded theory; strategies for qualitative research. Nurs Res. 1968;17:364.

    Article  Google Scholar 

  64. Miles MB, Huberman AM. Drawing valid meaning from qualitative data: toward a shared craft. Educ Res. 1984;13:20–30.

    Article  Google Scholar 

  65. Strauss A, Corbin J. Basics of qualitative research: procedures and techniques for developing grounded theory. Thousand Oaks, CA: Sage; 1998.

    Google Scholar 

  66. QSR International. NVivo Softw. 2018.

  67. Hartley M, Tomlinson M, Greco E, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8:9.

    Article  Google Scholar 

  68. Peltzer K, Rodriguez VJ, Jones D. Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa. SAHARA-J: J Soc Aspects of HIV/AIDS. 2016;13:60–67.

  69. Stellenberg EL, Abrahams JM. Prevalence of and factors influencing postnatal depression in a rural community in South Africa. Afr J Prim Health Care Fam Med. 2015;7. Epub ahead of print. https://doi.org/10.4102/phcfm.v7i1.874.

  70. Cook JA, Cohen MH, Burke J, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. JAIDS J Acquir Immune Defic Syndr. 2002;30:401–9.

    Article  Google Scholar 

  71. Koenig LJ, O’Leary A. Improving health outcomes for women with HIV: the potential impact of addressing internalized stigma and depression. AIDS. 2019;33:577–9.

    Article  Google Scholar 

  72. Torres TS, Harrison LJ, La Rosa AM, et al. Quality of life among HIV-infected individuals failing first-line antiretroviral therapy in resource-limited settings. AIDS Care. 2018;30:954–62.

    Article  Google Scholar 

  73. Knettel BA, Cichowitz C, Ngocho JS, et al. Retention in HIV care during pregnancy and the postpartum period in the option B+ era: systematic review and meta-analysis of studies in Africa. JAIDS J Acquir Immune Defic Syndr. 2018;77:427–38.

    Article  Google Scholar 

  74. Phillips TK, Clouse K, Zerbe A, et al. Linkage to care, mobility and retention of HIV-positive postpartum women in antiretroviral therapy services in South Africa. J Intern AIDS Soc. 2018;21:e25114.

  75. Bass J, Neugebauer R, Clougherty KF, et al. Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: randomised controlled trial. Br J Psychiatry. 2006;188:567–73.

    Article  Google Scholar 

  76. Bennett DS, Traub K, Mace L, et al. Shame among people living with HIV: a literature review. AIDS Care. 2016;28:87–91.

    Article  Google Scholar 

  77. Himelhoch S, Medoff DR, Oyeniyi G. Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis. AIDS Patient Care STDS. 2007;21:732–9.

    Article  Google Scholar 

  78. Shibasaki WM, Martins RP. Simple randomization may lead to unequal group sizes. Is that a problem? Am JOrthod Dentofacial Orthop. 2018;154:600–605.

  79. Nakasujja N, Vecchio AC, Saylor D, et al. Improvement in depressive symptoms after antiretroviral therapy initiation in people with HIV in Rakai. Uganda J Neurovirol. 2021;27:519–30.

    Article  CAS  Google Scholar 

  80. Hanlon C. Maternal depression in low- and middle-income countries. Int Health. 2013;5:4–5.

    Article  Google Scholar 

  81. Prince M, Patel V, Saxena S, et al. No health without mental health. The Lancet. 2007;370:859–77.

    Article  Google Scholar 

  82. Besser M. Mothers 2 Mothers. Search Results Web results South African Journal of Obstetrics and Gynaecology. 2006;12:122–8.

    Google Scholar 

  83. Barnett ML, Lau AS, Miranda J. Lay health worker involvement in evidence-based treatment delivery: a conceptual model to address disparities in care. Annu Rev Clin Psychol. 2018;14:185–208.

    Article  Google Scholar 

  84. Honikman S, van Heyningen T, Field S, et al. Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa. PLoS Med. 2012;9:e1001222.

  85. Vythilingum B, Field S, Kafaar Z, et al. Screening and pathways to maternal mental health care in a South African antenatal setting. Arch Womens Ment Health. 2013;16:371–9.

    Article  CAS  Google Scholar 

  86. Iyun V, Brittain K, Phillips TK, et al. Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study. BMJ Open. 2018;8:e019979.

  87. Farquhar C, Kiarie JN, Richardson BA, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. JAIDS J Acquir Immune Defic Syndr. 2004;37:1620–6.

    Article  Google Scholar 

  88. Hampanda K, Abuogi L, Musoke P, et al. Development of a novel scale to measure male partner involvement in the prevention of mother-to-child transmission of HIV in Kenya. AIDS Behav. 2020;24:291–303.

    Article  Google Scholar 

  89. Matseke MG, Ruiter RAC, Rodriguez VJ, et al. Factors associated with male partner involvement in programs for the prevention of mother-to-child transmission of HIV in rural South Africa. IJERPH. 2017;14:1333.

    Article  Google Scholar 

  90. Montgomery E, van der Straten A, Torjesen K. “Male involvement” in women and childrenʼs HIV prevention: challenges in definition and interpretation. JAIDS J Acquir Immune Defic Syndr. 2011;57:e114–6.

    Article  Google Scholar 

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Funding

This work was supported by the National Institute of Mental Health (NIMH) under grant K23MH096651 (PI Psaros), with some of the investigator effort supported by 9K24DA040489 (Safren) and T32MH116140 (Stanton). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA

    Christina Psaros, Amelia M. Stanton, Greer A. Raggio & Georgia R. Goodman

  2. National Center for Weight and Wellness, Washington, D.C., USA

    Greer A. Raggio

  3. MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa

    Nzwakie Mosery & Jenni Smit

  4. The Fenway Institute, Fenway Health, Boston, MA, USA

    Georgia R. Goodman

  5. Department of Health Systems & Population Health, University of Washington, Seattle, WA, USA

    Elsa S. Briggs

  6. Department of Community Health Science, Boston University, Boston, MA, USA

    Elsa S. Briggs

  7. Howard University College of Medicine, Washington, D.C., USA

    Marcel Williams

  8. OHSU-PSU School of Public Health, Portland, OR, USA

    David Bangsberg

  9. Department of Psychology, University of Miami, Miami, FL, USA

    Steven A. Safren

  10. Boston, USA

    Christina Psaros

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All procedures were in accordance with the ethical standards of all institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants included in the study.

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Steven Safren receives royalties from Oxford University Press, Guilford Publications, and Springer/Humana Press for book royalties related to cognitive behavioral therapy and other evidenced-based treatments. The other authors of this manuscript have declared no conflicts of interest.

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Dr. Greer Raggio and Elsa S. Briggs were affiliated with the Department of Psychiatry at Massachusetts General Hospital in Boston, MA, at the time the research was conducted. Dr. Raggio is now primarily affiliated with the National Center for Weight and Wellness in Washington, DC, and Ms. Briggs is now primarily affiliated with the Department of Health Systems & Population Health at the University of Washington in Seattle, WA.

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Psaros, C., Stanton, A.M., Raggio, G.A. et al. Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial. Int.J. Behav. Med. 30, 62–76 (2023). https://doi.org/10.1007/s12529-022-10071-z

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