Improving HAART Adherence in Depressed HIV Clinic Patients: A Real-World RCT
This project will integrate a depression treatment and brief medication adherence counseling intervention into clinical care at three HIV clinics and will use a randomized controlled trial to assess whether, relative to usual care, the intervention leads to improved HIV medication adherence. The depression treatment intervention uses a model known as Measurement-Based Care (MBC), which equips care coordinators with systematic measurement tools, a decision algorithm and psychiatric backup, and trains them to provide decision support to HIV clinicians to implement, monitor, and adjust antidepressant therapy.
The main goal of the project is to assess the impact of MBC and brief Motivational Interviewing (MI) adherence counseling on ART adherence and clinical outcomes among depressed people living with HIV/AIDS (PLWHA). MBC employs clinical coordinators (CCs) with expertise in depression management to screen for depression and help non-psychiatric physicians implement guideline-concordant, algorithm-driven antidepressant treatment. The CC uses standardized metrics (depressive symptoms, side effects) and an algorithm to monitor treatment response and recommend changes. Weekly supervision from a psychiatrist ensures quality care. Biweekly contact between patients and the CC will include brief MI adherence counseling. We will recruit 390 PLWHA on ART with confirmed depression, and will conduct a randomized trial of the MBC intervention versus enhanced usual care. Our three HIV clinical sites in North Carolina have a long history of collaboration on HIV behavioral health research.
Our aims are:
1. to test whether MBC improves ART adherence and HIV clinical outcomes;
2. to assess the cost-effectiveness of MBC; and
3. to collect process measures concerning MBC implementation to inform replication at other sites.
Since the CC role can be effectively filled by a behavioral health provider or nurse given appropriate training and supervision and the intervention has limited time requirements, this model is potentially replicable to a wide range of resource-constrained HIV treatment settings.
Project Policy Impact Description
Clinical benefit of treating depression in HIV patients
- NIH-National Institute of Mental Health
- University of North Carolina
- University of Alabama at Birmingham