Discussion
depression, CMD, virologic suppression, viral suppression
In this cluster randomized trial, we examined the effect of the FB intervention on ART outcomes and mental health symptoms in adults with HIV in rural Zimbabwe. The intervention did not demonstrate a clear effect on ART adherence, viral suppression, and symptoms of depression (PHQ-9 scores) but had a beneficial effect on CMD symptoms (SSQ-14 scores). Characteristics of the study population at enrollment, including the high proportion of women, high baseline adherence, high baseline viral suppression rates, and relatively low mean PHQ-9 scores, may have contributed to the negative findings of this trial. The FB intervention was found to be a feasible and acceptable approach to address the mental health care needs of the rural study population. Implementing this psychological intervention led by lay health workers in rural health facilities was successful, with almost 90% of participants attending all 6 individual counseling sessions, reflecting their satisfaction and intervention appropriateness.With the present study, 3 trials show that the FB intervention can reduce CMD symptoms (eFigure in Two of the 3 trials examined virologic suppression (this study and the trial among adolescents