Comparative Efficacy and Acceptability of Non-pharmacological Interventions for Depression Among People Living With HIV: Protocol for a Systematic Review and Network-meta Analysis

Abstract

\n Background: Improving depression is critical to successful HIV treatment. Due to the adverse reactions of pharmacotherapy, treatment for depression in PLWH has increasingly turned to non-pharmacological treatments. However, the comparative efficacy and acceptability of non-pharmacological treatments for depression among PLWH in different resource contexts remain inconclusive. This protocol for a systematic review and network meta-analysis aims at evaluating the efficacy and acceptability of non-pharmacological treatments for depression among PLWH to guide future research and practice for all research settings and for low-income and middle-income countries (LMIC) only. Methods: We will include all randomized controlled trials of any non-pharmacological interventions to reduce depression in PLWH. The primary outcomes will be the efficacy (the overall mean change scores in depression) and acceptability (the proportion of participants who withdrew for any reason). We will systematically search Published studies through the related databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL) and the bibliographies. There is no restriction by language and publication year. At least two investigators will independently conduct all study selection, quality evaluation, and data extraction. We will employ a network meta-analysis to synthesize all available evidence for each outcome and obtain a comprehensive ranking of all interventions for the global network and for low-income and middle-income countries (LMICs) network only. We will employ validated local and global approaches to assess inconsistency. We will use OpenBUGS (version 3.2.3) to fit our model into the Bayesian framework. We will evaluate the strength of evidence with the GRADE system. Discussion: We will synthesize all available evidence and identify the most efficacious and acceptable non-pharmacological interventions for depression among PLWH for global network and for LMIC network only. The results of this study will be used to guide decision-making better in different resource settings.Systematic review registration: PROSPERO CRD42021244230.