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Objective: We assessed the validity of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) as a screen for depression in Rwandan children and adolescents. Although the CES-DC is widely used for depression screening in high-income countries, its validity in low-income and culturally diverse settings, including sub-Saharan Africa, is unknown. Method: The CES-DC was selected based on alignment with local expressions of depression-like problems in Rwandan children and adolescents. To examine criterion validity, we compared CES-DC scores to depression diagnoses on a structured diagnostic interview, the Mini International Neuropsychiatric Interview for Children (MINI KID), in a sample of 367 Rwandan children and adolescents aged 10 through 17 years. Caregiver and child or adolescent self-reports endorsing the presence of local depression-like problems "agahinda kenshi" (persistent sorrow) and "kwiheba" (severe hopelessness) were also examined for agreement with MINI KID diagnosis. Results: The CES-DC exhibited good internal reliability (alpha = 0.86) and test-retest reliability (r = 0.85). The area under the receiver operating characteristic curve for the CES-DC was 0.825 when compared to MINI KID diagnoses, indicating a strong ability to distinguish between depressed and nondepressed children and adolescents in Rwanda. A cut point of equal to or greater than 30 corresponded with a sensitivity of 81.9% and a specificity of 71.9% in this referred sample. MINI KID diagnosis was well aligned with local expressions of depression-like problems. Conclusion: The CES-DC demonstrates good psychometric properties for clinical screening and evaluation in Rwanda, and should be considered for use in this and other low-resource settings. Population samples are needed to determine a generalizable cut point in nonreferred samples. (Contains 3 tables and 2 figures.)

BackgroundChildren affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent-child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services.MethodsEighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7-17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points.Trial registrationNCT01509573, 'Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573?term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1.ResultsAt 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (β = -.246; p = .009) and parent report (β = -.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting.ConclusionsFamily-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators.

To serve the unique needs of HIV-positive adolescents, an adolescent-focused HIV program, which included clinical, psychosocial, and community-based services, was established in rural Rwanda. From October 1, 2009, to February 1, 2011, 206 HIV-positive adolescents aged 11 to 19 years were enrolled, of whom 10 transferred care out of the program. Overall, 191 (97.5%) of 196 adolescents were retained, 4 (2%) were lost to follow-up, and 1 (0.5%) died. Median follow-up time was 4.6 (interquartile range 3.2 to 5.7) years. Among 124 patients on antiretroviral therapy (ART) for at least 1 year, median CD4 increase was 347 cells/mm3(36 to 553), and 87% achieved virologic suppression (<500 copies/mL). Clinic attendance was high, with 90.8% and 88.5% of ART-initiated and pre-ART patients, respectively, attending the clinic within 90 days of the end of the follow-up period. Our findings suggest that integrated, comprehensive, and youth-friendly clinics for HIV-positive adolescents can be successful in rural, resource-poor settings. [ABSTRACT FROM PUBLISHER]