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Research and Advances in Psychiatry

Accuracy of depression evaluations by trained lay and medical health workers in HIV clinics in Uganda

Original Article, 44 - 52
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Background: in task-shifted care, lower trained cadres assume the responsibilities normally held by higher trained, but scarcer personnel. Such approaches have been used in delivery of health care services in low resourced setting particularly in sub-Saharan Africa. Some work in general primary health care supports the use of lay and medical providers to screen for, and diagnose depression. However, little has been done in HIV care settings.
Methods: this was a cluster randomized trial of two task-shifting depression care models (structured protocol arm versus a clinical acumen arm) at 10 HIV clinics in Uganda. Lay health care workers (LHCW) screened clients using the short form of the Patient Health Questionnaire (PHQ-2), and referred screen positive cases (PHQ-2≥3) to the clinic nurses for further assessment using the PHQ-9. Trained master’s level psychologist research assistants (RA) administered the PHQ-2 to a random number of screen positive cases as the validity criterion.
Results: there was a 0.59 (p<0.001) correlation between the PHQ-2 scores of the trained LHCW and the RA’s. Of the 834 clients evaluated by the nurses, 81.2% received the same classification (PHQ-9≥9) as that from the RA’s with a correlation of 0.69 (p<.001). Controlling for clustering and time fixed effects, PHQ-2 equivalence and PHQ-9 classification concordance were unrelated to the depression care model, as well as client and provider characteristics, and accuracy was stable over time.
Conclusion: findings show that LHCW and medical health workers can accurately screen and evaluate depression.