Adaptation of a Depression Treatment Intervention for HIV Patients in Cameroon

描述（由申请人提供）：精神疾病是HIV感染临床管理中的一个严重问题。在美国，情绪和焦虑症影响了多达一半的HIV阳性患者。在资源贫乏的国家，艾滋病毒携带者患精神疾病的比例也同样较高。抑郁症与一系列与艾滋病毒相关的负面行为和临床健康结果有关，包括更多的性风险行为、更差的抗逆转录病毒治疗（ART）依从性、对ART的反应较差、免疫系统衰退更快、死亡率更高。被称为“基于测量的护理”（MBC）的方法整合到初级保健环境中，有效地解决了非艾滋病毒患者人群的共病性抑郁症。多地点随机临床试验已经证明了MBC模型的有效性，该模型雇用具有抑郁症专业知识的临床协调员来帮助医生实施符合指南的、算法驱动的抗抑郁治疗。在撒哈拉以南非洲（SSA），为艾滋病毒患者制定有效的、文化上适当的心理健康干预措施尤为紧迫，因为在估计的3 300万艾滋病毒感染者中，近三分之二居住在这里。联合抗逆转录病毒治疗刚刚开始在该地区得到广泛应用。抗逆转录病毒治疗的成功和耐药性的预防取决于严格的药物依从性。由于抑郁症是依从性差的最一致的预测因素之一，并且已被专家小组宣布为世界各地艾滋病毒管理中的一个重要问题，因此迫切需要经过检验的干预措施，以解决非洲艾滋病毒临床环境中的心理健康问题。在目前的R34申请中，我们建议评估实施MBC抑郁管理计划的随机对照试验（RCT）的可行性和可接受性，该计划主要由护士组成，并整合到HIV临床护理站点。由于北卡罗来纳大学教堂山艾滋病研究中心与喀麦隆雅温得大学传染病研究和控制中心之间的长期合作关系，项目活动将在喀麦隆的英语区域进行。我们的具体目标是：(1)建立病例识别方案的有效性、可靠性和文化适宜性，以识别英语喀麦隆半城市HIV临床护理点的重度抑郁症（MDD）患者；(2)将MDD患者的MBC治疗干预措施与喀麦隆艾滋病毒治疗的背景相适应，并培训艾滋病毒提供者和护士实施干预措施；(3)评估从我们的合作诊所招募和留住患者以及收集和处理实验室标本的可行性。如果我们的干预被证明是可行的，并显示出潜在的有效性，我们将竞争R01资金。这笔后续资金将允许我们实施一项随机对照试验，研究这种抑郁症识别和治疗方案对抗逆转录病毒治疗依从性、艾滋病毒临床指标和心理健康结果的影响。

DESCRIPTION (provided by applicant): Mental illness is a serious concern in the clinical management of HIV infection. In the United States, mood and anxiety disorders affect up to half of HIV+ patients. HIV+ individuals in resource-poor countries have similarly elevated rates of mental illnesses. Depression has been linked to a range of negative HIV-related behavioral and clinical health outcomes, including more sexual risk behaviors, worse antiretroviral therapy (ART) adherence, poor response to ART, faster immune system decline, and higher mortality. Approaches known as "Measurement-Based Care" (MBC) integrated into primary care settings have effectively addressed comorbid depression in non-HIV patient populations. Multisite randomized clinical trials have demonstrated the efficacy of MBC models, which employ clinical coordinators with depression expertise to help physicians implement guideline-concordant, algorithm-driven antidepressant treatment. The development of effective, culturally appropriate mental health interventions for HIV patients is particularly time-critical in sub-Saharan Africa (SSA), home to nearly two-thirds of the estimated 33 million people infected with HIV. Combination ART is just starting to become widely available in the region. Successful ART treatment and the prevention of drug resistance hinge on strict medication adherence. As depression is one of the most consistent predictors of poor adherence and has been declared by expert panels to be an important concern in the management of HIV around the world, tested interventions to address mental health issues in African HIV clinical settings are sorely needed. In the present R34 application, we propose to assess the feasibility and acceptability of implementing a randomized controlled trial (RCT) of an MBC depression management program that is primarily staffed by nurses and integrated into HIV clinical care sites. Project activities will take place in the English-speaking region of Cameroon due to the long-standing collaborative relationship between the University of North Carolina-Chapel Hill Center for AIDS Research and the Center for the Study and Control of Communicable Diseases of the University of Yaound¿ in Yaound¿, Cameroon. Our specific aims are to (1) Establish the validity, reliability, and cultural appropriateness of a case identification protocol to identify patients with major depressive disorder (MDD) at a semi-urban HIV clinical care site in English-speaking Cameroon; (2) Adapt an MBC treatment intervention for patients with MDD to the context of HIV treatment in Cameroon, and train HIV providers and nurses in implementing the intervention; and (3) Evaluate the feasibility of recruiting and retaining patients from our partnering clinic and collecting and processing laboratory specimens. Should our intervention prove feasible and demonstrate evidence of potential effectiveness, we will compete for R01 funding. This subsequent funding would permit us to implement an RCT of the effect of this depression identification and treatment protocol on ART adherence, HIV clinical indicators, and mental health outcomes.