This cross-sectional study was conducted at three purposively selected HIV Care and Treatment Clinics (CTCs) which are attached to hospitals in the Kilimanjaro Region of Tanzania: Mawenzi Regional Referral Hospital, Hai District Hospital and Majengo Health Centre. The health centres were chosen to include facilities of varying size, location (urban, suburban, and rural), and referral capacity with the intention to recruit a wider diversity of participants from first visit consultations (small health centre and district level) to those who had been referred due to more complex challenges (regional referral level).
Eligible patients were adults 18 years and above, diagnosed with HIV within the past 12 months, and able to provide informed consent. Participants who could not write their signature were able to document their informed consent with a fingerprint. Full informed consent forms were read aloud in the presence of an interpreter and a witness who also provided signatures in support of the participants’ informed consent. We excluded patients whose physical or mental condition made them unable to participate and those who had previously experienced a manic or hypomanic episode to rule out bipolar disorder. We ruled these conditions out by including two questions based on criteria A under the sections on manic and hypomanic episodes in the DSM 5. A ‘yes’ response to either of these questions led to exclusion from the study.
The desired sample size (N = 272) was calculated using an equation taken from Cochran’s formula: N=[Z2P(1-P)]/d2 whereby ‘N’ is the estimated desired sample size, ‘Z’ represents the confidence level at 95%, ‘P’ stands for the prevalence of depression, and ‘d’ represents the margin of error at 5% [36 ]. We used a previous study [35 (link)] from Tanzania to obtain an estimated prevalence of depression. We then recruited 272 individuals presenting for routine HIV care appointments at the three study sites. The number of participants recruited per study site was proportional to the number of patients seen at each clinic. For measures that were neither translated nor validated previously in Tanzania, a formal forward- and back-translation was done by two Muhimbili University of Health and Allied Sciences (MUHAS) staff members not part of the study team, then compared with the original tools for linguistic and cultural equivalence.
Eligible patients were adults 18 years and above, diagnosed with HIV within the past 12 months, and able to provide informed consent. Participants who could not write their signature were able to document their informed consent with a fingerprint. Full informed consent forms were read aloud in the presence of an interpreter and a witness who also provided signatures in support of the participants’ informed consent. We excluded patients whose physical or mental condition made them unable to participate and those who had previously experienced a manic or hypomanic episode to rule out bipolar disorder. We ruled these conditions out by including two questions based on criteria A under the sections on manic and hypomanic episodes in the DSM 5. A ‘yes’ response to either of these questions led to exclusion from the study.
The desired sample size (N = 272) was calculated using an equation taken from Cochran’s formula: N=[Z2P(1-P)]/d2 whereby ‘N’ is the estimated desired sample size, ‘Z’ represents the confidence level at 95%, ‘P’ stands for the prevalence of depression, and ‘d’ represents the margin of error at 5% [36 ]. We used a previous study [35 (link)] from Tanzania to obtain an estimated prevalence of depression. We then recruited 272 individuals presenting for routine HIV care appointments at the three study sites. The number of participants recruited per study site was proportional to the number of patients seen at each clinic. For measures that were neither translated nor validated previously in Tanzania, a formal forward- and back-translation was done by two Muhimbili University of Health and Allied Sciences (MUHAS) staff members not part of the study team, then compared with the original tools for linguistic and cultural equivalence.
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