.png)
Cognitive Behavioral Therapy for Mental Health and Stigma Among PLWH in Low and Middle-Income Countries: A Systematic Review
Abstract
burden of mental health disorders and HIV-related stigma, which critically hinders adherence to antiretroviral therapy (ART). Cognitive Behavioral Therapy (CBT) has emerged as a promising evidence-based psychological intervention. However, its effectiveness across diverse populations and delivery formats in LMICs has not been adequately synthesized. This systematic review aimed to evaluate the effectiveness of CBT on mental health and stigma reduction among PLWH in LMICs. A systematic review was conducted in accordance with the PRISMA guidelines for RCT articles published in Scopus, Science Direct, and PubMed databases between January 1, 2021, to April 9, 2026. The keywords used were “Cognitive Behavioral Therapy” AND “Mental Health OR Stigma” AND “People Living with HIV” OR “Randomized Controlled Trial.” Risk of bias was assessed using the Cochrane Risk of Bias Tool version 2 (RoB 2). Seven RCTs involving 1.786 participants from six LMICs in Africa and one in South Asia were included. All studies consistently reported clinically significant reductions in depressive symptoms and internalized stigma following CBT interventions, regardless of group, individual, or self-administered delivery format, and regardless of whether the intervention was delivered by a mental health specialist or a trained non-specialist. The risk of bias assessment indicated that one study had a low risk of bias, and six studies had some concerns. CBT is an effective, flexible, and scalable intervention for improving mental health and reducing stigma among PLWH in LMICs.
Full Text:
PDFReferences
1. Fauk NK, Mwanri L, Hawke K, Mohammadi L, Ward PR. Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries : A Systematic Search and Critical Review. Int J Environ Res Public Heal Rev. 2022;1–25. https://doi.org/10.1101/2022.04.16.22273930
Ji J, Zhang Y, Ma Y, Jia L, Cai M, Li Z, et al. People who living with HIV/AIDS also have a high prevalence of anxiety disorders: a systematic review and meta-analysis. Front psychiatry. 2024;15:1259290. https://doi.org/10.3389/fpsyt.2024.1259290
Bergman AJ, Id KCM, Mlandu K, Id AA, Flores DD. Identity management in the face of HIV and intersecting stigmas : A metasynthesis of qualitative reports from sub-Saharan Africa. PLOS Glob PUBLIC Heal. 2023;3(2):1–20. https://doi.org/10.1371/journal.pgph.0000706
Armoon B, Fleury MJ, Bayat AH, Fakhri Y, Higgs P, Moghaddam LF, et al. HIV related stigma associated with social support , alcohol use disorders , depression , anxiety , and suicidal ideation among people living with HIV : a systematic review and meta ‑ analysis. Int J Ment Health Syst. 2022;1–17. https://doi.org/10.1186/s13033-022-00527-w
UNAIDS. Global HIV & AIDS statistics. 2025 [cited 2026 Apr 1]. Available from: https://www.unaids.org/en/resources/fact-sheet
Tadesse G, Rtbey G, Andualem F, Takelle GM, Melkam M, Tadesse Abate A, et al. HIV-related perceived stigma and internalized stigma among people living with HIV/AIDS in Africa: A systematic review and meta-analysis. PLoS One. 2024;19(10):e0309231. https://doi.org/10.1371/journal.pone.0309231
Dessie ZG, Zewotir T. HIV-related stigma and associated factors: a systematic review and meta-analysis. Front public Heal. 2024;12:1356430. https://doi.org/10.3389/fpubh.2024.1356430
Zeleke TA, Alemu K, Ayele TA, Denu ZA, Mwanri L, Azale T. Systematic review and meta-analysis on the effect of depression on ART adherence among women living with HIV. PLoS One. 2024;19(6):e0300106. https://doi.org/10.1371/journal.pone.0300106
Dave P. Journal of Drug Delivery and Therapeutics The Correlation Between Stigma and Mental Health Disorders in People Living with HIV / AIDS. J Drug Deliv Ther Open. 2024;14(3):227–33. https://doi.org/10.22270/jddt.v14i3.6490
Nwogwugwu C, Favor C, Fu Y, Iheanacho T. Interventions Integrating Mental Health Services Into HIV Care in Africa; a Scoping Review. Int J Public Health. 2025;70:1608137. https://doi.org/10.3389/ijph.2025.1608137
Miltz AR, Sewell J, Nakagawa F, Rein SM, Sherr L, Rodger A, et al. Evidence from high-income countries on the effectiveness of psychosocial interventions to improve mental health , wellbeing and quality of life for adults living with HIV : a systematic review and meta-analysis. J Int AIDS Soc. 2025;1–36. https://doi.org/10.1002/jia2.26424
Dhir AM, Singh A, Solomon S, Farley JE. Interventions for stigma reduction in HIV treatment and prevention designed to enhance antiretroviral uptake and adherence: A systematic review. PLOS Glob public Heal. 2025;5(5):e0004604. https://doi.org/10.1371/journal.pgph.0004604
Abbas Q, Nisa M, Khan MU, Anwar N, Aljhani S, Ramzan Z. Brief cognitive behavior therapy for stigmatization , depression , quality of life , social support and adherence to treatment among patients with HIV / AIDS : a randomized control trial. BMC Psychiatry. 2023;1–13. https://doi.org/10.1186/s12888-023-05013-2
Pulerwitz J, Gottert A, Tun W, Eromhonsele AF, Oladimeji PL, Shoyemi E, et al. Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria. J Int AIDS Soc. 2024 Jun;27(6):e26256. https://doi.org/10.1002/jia2.26256
Byansi W, Galvin M, Chiwaye L, Luvuno Z, Kim AW, Sundararajan R, et al. Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis. BMC Psychiatry. 2023 Aug;23(1):581. https://doi.org/10.1186/s12888-023-05085-0
Haumba S, Mavimbela S, Khumalo F, Maseko T. Addressing Mental Health Needs and Challenges Among People Living with HIV in Low- and Middle-Income Countries. Oliveira-Filho AB, de Souza Fonseca RR, editors. 2025. https://doi.org/10.5772/intechopen.1012817
Page MJ, McKenzie JE, Bossuyt P, Boutron I, Hoffmann TC, Mulrow CD, et al. The prisma 2020 statement: An updated guideline for reporting systematic reviews. Med Flum. 2021;57(4):444–65. https://doi.org/10.21860/medflum2021_264903
Vavani B, Garnefski N, Luenen S Van, Dusseldorp E, Olak KA p. A Booklet Self-Help Intervention for People Living with HIV and Depressive Symptoms in Botswana : A Randomized Controlled Trial. AIDS Behav. 2025;29(4):2855–68. https://doi.org/10.1007/s10461-025-04742-7
Kaaya S, Siril H, Fawzi MCS, Aloyce Z, Araya R, Kaale A, et al. A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options : A cluster-randomized controlled trial. PLOS Med. 2022;9(12):1–16. https://doi.org/10.1371/journal.pmed.1004112
Safren SA, Cleirigh CO, Andersen LS, Magidson JF, Lee JS, Bainter SA, et al. Treating depression and improving adherence in HIV care with task-shared cognitive behavioural therapy in Khayelitsha , South Africa : a randomized controlled trial. J Int AIDS Soc 2021. 2021;24:1–10. https://doi.org/10.1002/jia2.25823
Nabunya P, Ssewamala FM, Kizito S, Mugisha J, Brathwaite R, Neilands TB, et al. Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Pediatr. 2024;269:113983. https://doi.org/10.1016/j.jpeds.2024.113983
Donenberg GR, Fitts J, Ingabire C, Nsanzimana S, Fabri M, Emerson E, et al. Results of the Kigali Imbereheza Project: A 2-arm individually randomized trial of TI-CBT enhanced to address ART adherence and mental health for Rwandan youth living with HIV. J Acquir Immune Defic Syndr. 2023;90(1):69–78. https://doi.org/10.1097/QAI.0000000000002911
Feijó M, Vaitses Fontanari AM, da Silva LP, Dos Santos Boeira L, Wendt GW, Brandelli Costa A. HIV and mental health: a scoping review of systematic reviews about motivational interviewing and cognitive-behavioral interventions for people living with HIV. Psychol Health Med. 2026 Mar;31(3):722–38. https://doi.org/10.1080/13548506.2025.2565522
Kokubun CW, Carlson MS, Druss BG, Woods-Jaeger BA, Kalokhe AS, Sales JM. A global scoping review of task shifting and sharing interventions to improve the mental health of people living with HIV/AIDS. Glob Ment Heal. 2025;12:e58. https://doi.org/10.1017/gmh.2025.10013
Coelho DRA, Njiro BJ, Yussuf MH, Mikomangwa WP, Vieira WF, Papatheodorou S, et al. Cognitive behavioral therapy for antiretroviral therapy adherence and treatment outcomes among people living with HIV: a systematic review and meta-analysis. Nature Ment Heal. 2025 Jun;3(6):735–46. https://doi.org/10.1038/s44220-025-00444-0
Asrat B, Schneider M, Ambaw F, Lund C. Effectiveness of psychological treatments for depressive symptoms among people living with HIV/AIDS in low- and middle-income countries: A systematic review and meta-analysis. J Affect Disord. 2020 Jun;270:174–87. https://doi.org/10.1016/j.jad.2020.03.068
Du Zeying M, Ashcroft T, Kulkarni D, Sawrikar V, Jackson CA. Psychosocial interventions for depression delivered by non-mental health specialists to people living with HIV/AIDS in low- and middle-income countries: A systematic review. J Glob Health. 2022 Jun;12:4049. https://doi.org/10.7189/jogh.12.04049
DOI: https://doi.org/10.70111/hg4212
Refbacks
- There are currently no refbacks.
"Health Gate"
ISSN 2986-1098
Indexing:
Published by The Regional Leadership Council of the Indonesian National Nurses Association, Blitar City
Kalimantan Street, Kel.Karangtengah, Kec. Sananwetan, Blitar City, East Java, Indonesia
Creative Commons Lisences