Telemedicine to Improve Depression and Adherence in HIV+ Women in the Rural South

远程医疗可改善南方农村地区艾滋病毒妇女的抑郁症和依从性

• 批准号: 8469090
• 负责人: MIRJAM-COLETTE KEMPF
• 金额: $ 21.55万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-11 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8469090
• 关键词: AIDS/HIV problem; Address; Adherence; Affect; Alabama; Anti-Retroviral Agents; Caring; Clinical; Cognitive Therapy; Comorbidity; County; Deep South; Depressed mood; Depressive disorder; Development; Disease; Economically Deprived Population; Epidemic; Equipment; Female; Focus Groups; Gender; Goals; HIV; HIV diagnosis; Health Personnel; Health Services Accessibility; Healthcare; Housing; Individual; Intervention; Intervention Studies; Interview; Lead; Left; Life; Link; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Minority; Morbidity - disease rate; Outcome; Participant; Patients; Population; Prevalence; Problem Solving; Process; Provider; Public Health; Randomized Controlled Trials; Recruitment Activity; Regimen; Research; Research Personnel; Rural; Rural Population; Services; Site; Solutions; Technology; Telemedicine; Testing; Therapeutic; Transportation; United States; United States National Institutes of Health; Vulnerable Populations; Woman; Work; antiretroviral therapy; base; clinical care; coping; cost effectiveness; depressive symptoms; effective intervention; efficacy testing; experience; girls; health care delivery; health disparity; improved; informant; innovation; male; medical specialties; meetings; men; mortality; open label; patient population; peer; psychologic; psychosocial; rural area; skills training; therapy adherence; therapy design; underserved rural area

DESCRIPTION (provided by applicant): Depression has been recognized as a strong predictor of HIV care non-adherence, and consequently of increased morbidity and mortality. HIV-infected women are disproportionally affected by co-morbid depression in comparison to HIV-infected men. However, interventions addressing the psychosocial needs of HIV-infected women, particularly in the rural Deep South of the United States where HIV prevalence remains high, are limited. To address this fundamental gap in HIV care of HIV-infected women, the long-term goal is to develop an effective intervention that significantly improves clinical outcomes in HIV-infected women by decreasing depression morbidity and simultaneously increasing both adherence to antiretroviral therapy (ART) and retention in care. The objective of this application is to culturally adapt an established and effective cognitive- behavioral therapy for depression and antiretroviral therapy adherence (CBT-AD) and test its feasibility and acceptability to HIV care adherence among HIV-infected minority women living in the rural South of the US. Teleconferencing/telemedicine technology will be used to overcome structural barriers to health care access (e.g. transportation, access to mental health service providers) persistent in rural areas. To accomplish this objective, the specific aims of this proposal are: 1) To conduct formative research (i.e. focus groups, individual key informant interviews) among HIV-infected women and HIV care providers to inform the cultural adaptation of the CBT-AD intervention for HIV-infected women in rural areas of Alabama; 2) To systematically adapt the CBT-AD intervention to HIV-infected depressed women residing in rural Alabama and telemedicine technology, using an iterative open-label - non-randomized process; and 3) To assess the feasibility, acceptability and preliminary efficacy of the adapted CBT-AD in reducing depression and improving ART adherence and retention in care among HIV-infected depressed women via a pilot randomized controlled trial (RCT). Participants will be recruited from three HIV care organizations serving 47 counties across Alabama, including 668 HIV-infected women in 2010. All sites are connected through telemedicine equipment facilitating the delivery of mental health service into rural areas in this proposal. The contribution of the proposed research is significant since it is the first step in a continuum of research that is expected to lead to the development o therapies that meet the gender-specific, psychological and medical needs of HIV-infected women to improve adherence to ART and retention in care. The research proposed in this application is innovative because of: 1) Its focus on an understudied vulnerable population, namely HIV-infected women residing in the Deep South who have been shown to be economically disadvantaged and burdened by high rates of depression; 2) Its plan to culturally adapt an intervention that aims at decreasing depression morbidity and simultaneously increases retention and adherence to HIV care and 3) Its use of telemedicine technology, which will allow for barriers of access to care and mental health services to be addressed.

描述（由申请人提供）：抑郁症已被认为是艾滋病毒护理不依从性的强有力预测因子，因此发病率和死亡率增加。与感染艾滋病毒的男子相比，感染艾滋病毒的妇女更容易受到共病抑郁症的影响。然而，针对感染艾滋病毒妇女的心理社会需要的干预措施有限，特别是在艾滋病毒流行率仍然很高的美国南方腹地农村地区。为了解决艾滋病毒感染妇女艾滋病毒护理方面的这一根本差距，长期目标是制定有效的干预措施，通过降低抑郁症发病率，同时提高抗逆转录病毒治疗的坚持率和继续接受护理，显著改善艾滋病毒感染妇女的临床结果。本申请的目的是在文化上适应抑郁症和抗逆转录病毒治疗依从性（CBT-AD）的既定和有效的认知-行为疗法，并测试其在生活在美国南部农村的艾滋病毒感染少数民族妇女中对艾滋病毒护理依从性的可行性和可接受性。将利用远程会议/远程医疗技术克服农村地区长期存在的获得保健服务的结构性障碍（如交通、获得心理健康服务提供者的服务）。为了实现这一目标，本建议的具体目标是：1）进行形成性研究在艾滋病毒感染妇女和艾滋病毒护理提供者中开展宣传活动（即焦点小组、个人关键信息提供者访谈），以宣传亚拉巴马农村地区艾滋病毒感染妇女的CBT-AD干预措施的文化适应性; 2）采用反复的开放标签非随机过程，系统地调整CBT-AD干预措施，使其适用于居住在亚拉巴马农村的感染艾滋病毒的抑郁妇女和远程医疗技术; 3）通过随机对照试验（RCT）评估适应性CBT-AD在减少HIV感染的抑郁妇女的抑郁和改善ART依从性和护理保留方面的可行性、可接受性和初步疗效。参与者将从为亚拉巴马47个县服务的三个艾滋病毒护理组织招募，其中包括2010年668名艾滋病毒感染妇女。所有站点都通过远程医疗设备连接起来，以便利在本提案中向农村地区提供心理健康服务。所提出的研究的贡献是显著的 因为这是一系列研究的第一步，预计这些研究将导致开发出满足艾滋病毒感染妇女的性别、心理和医疗需求的疗法，以提高抗逆转录病毒疗法的坚持率和护理的持续性。这项申请中提出的研究是创新性的，因为：1）其重点是研究不足的弱势群体，即居住在南方腹地的艾滋病毒感染妇女，她们已被证明在经济上处于不利地位，抑郁症发病率很高; 2）计划在文化上调整一项干预措施，旨在降低抑郁症发病率，同时提高艾滋病毒护理的保留率和坚持率;它使用远程医疗技术，这将有助于消除获得护理和心理健康服务的障碍。