Evaluation of a structured counseling program for depression reduction among people living with HIV in Southwest Ethiopia

Abstract Background: Depression is a prevalent comorbidity among people living with HIV/AIDS (PLWHA), particularly in sub-Saharan Africa, where high HIV prevalence intersects with limited mental healthcare resources. In Ethiopia, depression affects 30-50% of PLWHA; however, mental health services remain poorly integrated into HIV care programs. This study evaluates a structured counseling intervention designed to reduce depression among PLWHA in Southwest Ethiopian ART clinics, addressing a critical treatment gap in a resource-limited setting. Methodology: A quasi-experimental design using pre-test and post-test assessments was conducted with 128 participants (64 intervention, 64 control) recruited from four hospitals. The intervention included structured psychological counseling, stress management techniques, and peer-led support groups, delivered over four months alongside routine ART visits. Depression and suicide were assessed using the PHQ-9 and PSS-3, respectively, with data analyzed using SPSS version 24. Ethical approvals were obtained, and informed consent/assent was secured from all participants. Results: The intervention group showed a 48% reduction in mean depression scores (Cohen’s d = 1.19), with severe depression nearly eliminated (17.2% to 0.8%). Age-specific analyses revealed the most significant improvement among early adults (35-44 years; 76.9% to 7.7% moderate/severe depression), while youths and older adults exhibited less robust responses. The intervention also led to a 34.8% reduction in suicidal ideation. Notably, depression persisted among long-term ART patients (42.2% with >5 years on treatment), and substance use patterns remained unchanged, highlighting unmet psychosocial needs. Conclusion and recommendations: This study shows that a structured counseling intervention effectively lowers depression levels among HIV-positive individuals in ART clinics in Southwest Ethiopia, with a 48% reduction in depression scores and significant declines in suicidal thoughts. The intervention’s success varied by age, emphasizing the necessity for customized approaches, particularly for younger individuals and patients with substance use issues. It is advisable to integrate mental health services into HIV care programs to tackle this important comorbidity. Future research should investigate long-term effects, scalability, and methods for handling ongoing depression and substance use in this demographic.