A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.
A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.
复制标题
对HIV感染者的认知行为疗法的随机对照试验（CBT-AD）。
DOI：
10.1037/a0012715
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发表时间：
2009-01
影响因子：
4.2
通讯作者：
Mayer, Kenneth H.
中科院分区：
文献类型：
--
作者：
Safren, Steven A.;O'Cleirigh, Conall;Tan, Judy Y.;Raminani, Sudha R.;Reilly, Laura C.;Otto, Michael W.;Mayer, Kenneth H.
评估认知行为疗法对HIV感染者的药物依从性和抑郁症的影响。一项比较CBT-AD与仅常规强化治疗（ETAU）的两组、随机、对照、交叉试验。两组都接受了ETAU，包括一次坚持性的单次干预和一封给患者提供者的信，记录她或他持续的抑郁症。干预组还接受了10至12次CBT-AD治疗。通过药物事件监测系统（MEMs）评估抗逆转录病毒治疗依从性，通过设盲结构化评价评估抑郁症。在急性结局评估（3个月）中，接受CBT-AD的患者相对于对照组在药物依从性和抑郁症方面的改善明显更大。那些最初被分配到对照组，选择交叉到CBT-AD的人在抑郁和依从性结果方面表现出类似的改善。干预组患者的治疗增益通常在6个月和12个月随访评估时保持不变。到随访期结束时，最初分配CBT-AD的患者显示血浆HIV RNA浓度有所改善，尽管这些差异在交叉前没有出现，因此不存在组间差异。CBT-AD是一种潜在的有效方法，适用于患有抑郁症和依从性的HIV患者。需要在更大的疗效试验中进行复制和扩展。
To evaluate cognitive behavioral therapy to enhance medication adherence and reduce depression (CBT-AD) in individuals with HIV. A two arm, randomized, controlled, cross-over trial comparing CBT-AD, to enhanced treatment as usual only (ETAU). ETAU, which both groups received, included a single-session intervention for adherence and a letter to the patient’s provider documenting her or his continued depression. The intervention group also received 10 to 12 sessions of CBT-AD. Adherence to antiretroviral therapy as assessed by Medication Event Monitoring Systems (MEMs) and depression as assessed by blinded structured evaluation. At the acute outcome assessment (3-months), those who received CBT-AD evidenced significantly greater improvements in medication adherence and depression relative to the comparison group. Those who were originally assigned to the comparison group who chose to cross over to CBT-AD showed similar improvements in both depression and adherence outcomes. Treatment gains for those in the intervention group were generally maintained at 6 and 12-month follow-up assessments. By the end of the follow-up period, those originally assigned CBT-AD demonstrated improvements in plasma HIV RNA concentrations, though these differences did not emerge before the cross-over, and hence there were not between-group differences. CBT-AD is a potentially efficacious approach for individuals with HIV struggling with depression and adherence. Replication and extension in larger efficacy trials are needed.
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