Changes in HIV Outcomes Following Depression Care in a Resource-Limited Setting: Results from a Pilot Study in Bamenda, Cameroon.
Changes in HIV Outcomes Following Depression Care in a Resource-Limited Setting: Results from a Pilot Study in Bamenda, Cameroon.
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DOI：
10.1371/journal.pone.0140001
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Ndumbe P
中科院分区：
文献类型：
--
作者：
Gaynes BN;Pence BW;Atashili J;O'Donnell JK;Njamnshi AK;Tabenyang ME;Arrey CK;Whetten R;Whetten K;Ndumbe P
关于改善抑郁症护理如何影响非洲的艾滋病毒相关结果，人们知之甚少。在一个低收入撒哈拉以南国家的抑郁HIV患者样本中，我们探索了实施基于测量的抗抑郁治疗(MBC)在4个月的抗抑郁治疗中如何影响HIV结果。作为调整MBC用于喀麦隆的项目的一部分，我们招募了41名抑郁症艾滋病毒患者进行抗逆转录病毒治疗，在这项试点研究中，抑郁症护理经理(DCM)为门诊艾滋病毒临床医生提供了抗抑郁药物治疗的循证决策支持。前12周提供急性抑郁症治疗，DCM每2周接触一次，HIV临床医生每4周预约一次。我们在4个月时测量了HIV的临床和精神病学结果。参与者在基线时中度抑郁(平均患者健康问卷[PHQ]得分=14.4，范围13.1-15.6)。经过4个月的随访，所有HIV临床结果均有改善：平均(范围)CD4计数从436(2860)改善到452(132,876)，平均(范围)对数病毒载量从4.02(3.86，4.17)下降到3.15(2.81，3.49)，病毒抑制比例从0%提高到18%，平均(范围)HIV症状从6.4(5.5，7.3)下降到3.1(2.5，3.7)，健康状况良好的比例从18%提高到70%，在过去的一个月里，报告任何错过ARV剂量的比例从73%下降到55%。与此同时，精神病学措施有所改善。平均(范围)PHQ得分从14.4(13.1，15.6)降至1.6(0.8，2.4)，90%的患者抑郁得到缓解，不良应对方式得分下降，适应性应对得分和自我效能感得分提高。在这项针对喀麦隆艾滋病毒感染患者的循证抑郁症治疗干预的试点研究中，经过4个月的有效抑郁治疗，许多艾滋病毒行为和非行为健康结果有所改善。这些数据与更好的抑郁症护理可以改善艾滋病毒结果的假设是一致的。
Little is known about how improved depression care affects HIV-related outcomes in Africa. In a sample of depressed HIV patients in a low income, sub-Saharan country, we explored how implementing measurement-based antidepressant care (MBC) affected HIV outcomes over 4 months of antidepressant treatment. As part of a project adapting MBC for use in Cameroon, we enrolled 41 depressed HIV patients on antiretroviral therapy in a pilot study in which a depression care manager (DCM) provided an outpatient HIV clinician with evidence-based decision support for antidepressant treatment. Acute depression management was provided for the first 12 weeks, with DCM contact every 2 weeks and HIV clinician appointments every 4 weeks. We measured HIV clinical and psychiatric outcomes at 4 months. Participants were moderately depressed at baseline (mean Patient Health Questionnaire [PHQ] score = 14.4, range 13.1, 15.6). All HIV clinical outcomes improved by four month follow-up: mean (range) CD4 count improved from 436 (2, 860) to 452 (132, 876), mean (range) log-viral load decreased from 4.02 (3.86, 4.17) to 3.15 (2.81, 3.49), the proportion with virologic suppression improved from 0% to 18%, mean (range) HIV symptoms decreased from 6.4 (5.5, 7.3) to 3.1 (2.5, 3.7), the proportion reporting good or excellent health improved from 18% to 70%, and the proportion reporting any missed ARV doses in the past month decreased from 73% to 55%. Concurrently, psychiatric measures improved. The mean (range) PHQ score decreased from 14.4 (13.1, 15.6) to 1.6 (0.8, 2.4) and 90% achieved depression remission, while mean maladaptive coping style scores decreased and mean adaptive coping scores and self-efficacy scores improved. In this pilot study of an evidence-based depression treatment intervention for HIV-infected patients in Cameroon, a number of HIV behavioral and non-behavioral health outcomes improved over 4 months of effective depression treatment. These data are consistent with the hypothesis that better depression care can lead to improved HIV outcomes.