Telephone IPT Intervention for HIV-Infected Rural Persons

描述（由申请人提供）：与城市感染者相比，农村艾滋病毒感染者更有可能被诊断为抑郁症，更不可能向精神卫生专业人员寻求帮助，而且生存期似乎更短。该申请响应了PA-07-103（“农村精神健康和药物滥用障碍研究”）和PA声明的研究需求，该研究将“研究患有各种精神障碍的个体是否可以通过远程医疗得到有效治疗”。我们小组最近完成的一项试点随机对照试验显示，电话提供的6期人际心理治疗（IPT）干预减轻了79名农村艾滋病毒感染者的抑郁症状（Ransom， Heckman等人，2008年，精神病学服务）。这项后续随机对照试验将在美国农村县招募180名通过电话访谈被诊断为抑郁症的艾滋病毒/艾滋病感染者。参与者将在干预前、干预后以及4个月和8个月的随访中完成自我管理的调查，评估抑郁症状（主要结局指标）、人际关系问题、社会支持和抗逆转录病毒治疗依从性。参与者还将通过交互式语音应答（IVR）系统提供每周数据（41周），以评估抑郁症状（41周）和治疗联盟（9周）。90名（n=90）参与者将被随机分配到9个疗程，一对一，电话交付，IPT干预，90名参与者将被分配到常规护理对照组。线性混合模型（LMM）将测试IPT参与者报告的抑郁症状是否比常规护理对照组有更大的减轻。对可靠变化的分析将检验是否有更大比例的IPT参与者报告与常规护理对照组相比，抑郁症状有临床意义的减轻。使用通过IVR系统收集的每周数据，时间序列分析将测试IPT参与者在41周的随访期内是否报告抑郁症状比常规护理对照组有更大的减轻。混合模型分析将评估治疗联盟在电话IPT中的重要性。公共卫生意义：这项研究将测试9次电话人际心理治疗是否可以减轻农村艾滋病毒感染者的抑郁症状，这一群体的人数正在增加，并且很难获得精神卫生支持服务。

DESCRIPTION (provided by applicant): Compared to their urban counterparts, HIV-rural persons are more likely to be diagnosed with depression, less likely to seek assistance from mental health professionals, and appear to have shorter periods of survival. This application responds to PA-07-103 ("Research on Rural Mental Health and Drug Abuse Disorders") and the PA's stated need for research that will "Study whether individuals with various mental disorders can be treated effectively via telemedicine." A pilot RCT recently completed by our team showed that a 6-session telephone-delivered, interpersonal psychotherapy (IPT) intervention reduced depressive symptoms in 79 HIV- infected rural persons (Ransom, Heckman, et al., 2008, Psychiatric Services). This follow-up RCT will enroll 180 persons living with HIV/AIDS in rural counties in the United States who are diagnosed with depression via telephone interviews. Participants will complete self-administered surveys at pre-intervention, post- intervention, and 4- and 8-month follow-up that assess depressive symptoms (the primary outcome measure), interpersonal problems, social support, and ART adherence. Participants will also provide weekly data (for 41 weeks) via interactive voice response (IVR) systems that assess depressive symptoms (41 weeks) and therapeutic alliance (9 weeks). Ninety (n=90) participants will be randomly assigned to a 9-session, one-on- one, telephone-delivered, IPT intervention and 90 will be assigned to a usual care comparison group. Linear mixed models (LMM) will test if IPT participants report greater reductions in depressive symptoms compared to usual care controls. Analyses of reliable change will test if a greater proportion of IPT participants report clinically-significant reductions in depressive symptoms compared to usual care controls. Using weekly data collected via IVR systems, time series analyses will test if IPT participants report greater decreases in depressive symptoms over a 41-week follow-up period compared to usual care control. Mixed models analyses will assess the importance of therapeutic alliance in telephone-delivered IPT. Public Health Significance: This study will test if nine sessions of telephone-administered interpersonal psychotherapy can reduce depressive symptoms in HIV-infected rural persons, a group that is increasing in size and that experiences great difficulty accessing mental health support services.