Our Work

Strategies to Link Antiretroviral & Antidepressant Management (SLAM DUNC)

Project Objectives

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 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.

This a randomized controlled trial of an evidence-based depression treatment intervention known as Measurement-Based Care (MBC), combined with brief Motivational Interviewing (MI) adherence counseling, in depressed PLWHA to assess its impact on ART adherence and clinical outcomes. 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 provider-randomized trial of the MBC intervention versus enhanced usual care. Our 3 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 Outcomes

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.

Faculty

Department & School

Psychiatry
School of Medicine

Locations

Sponsors

  • NIH-National Institute of Mental Health

Collaborators

  • University of North Carolina

Project Status

Completed

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