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

描述（由申请人提供）：抑郁症已被认为是不遵守艾滋病毒治疗的强有力的预测因素，从而导致发病率和死亡率增加。与感染艾滋病毒的男性相比，感染艾滋病毒的女性更容易受到共病抑郁症的影响。然而，解决艾滋病毒感染妇女心理社会需求的干预措施有限，特别是在艾滋病毒感染率仍然很高的美国南部腹地农村地区。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，长期目标是开发一种有效的干预措施，通过降低抑郁症发病率并同时提高抗逆转录病毒治疗（ART）的依从性和护理保留率，显着改善艾滋病毒感染妇女的临床结果。该应用程序的目的是在文化上适应一种既定且有效的抑郁症认知行为疗法和抗逆转录病毒治疗依从性（CBT-AD），并测试其对生活在美国南部农村的感染艾滋病毒的少数族裔妇女的艾滋病毒护理依从性的可行性和可接受性。电话会议/远程医疗技术将用于克服农村地区持续存在的获得医疗保健的结构性障碍（例如交通、获得心理健康服务提供者）。为了实现这一目标，本提案的具体目标是： 1) 在 HIV 感染妇女和 HIV 护理提供者中开展形成性研究（即焦点小组、个人关键知情人访谈），为阿拉巴马州农村地区 HIV 感染妇女的 CBT-AD 干预措施的文化适应提供信息； 2) 使用迭代开放标签非随机过程，系统地调整 CBT-AD 干预措施以适应居住在阿拉巴马州农村地区的感染艾滋病毒的抑郁妇女和远程医疗技术； 3) 通过一项试点随机对照试验 (RCT) 评估改编后的 CBT-AD 在减少艾滋病毒感染抑郁症妇女的抑郁症和提高 ART 依从性和护理保留率方面的可行性、可接受性和初步疗效。参与者将从为阿拉巴马州 47 个县提供服务的三个艾滋病毒护理组织中招募，其中包括 2010 年的 668 名感染艾滋病毒的妇女。在本提案中，所有地点都通过远程医疗设备连接，以促进向农村地区提供心理健康服务。拟议研究的贡献是重大的 因为这是连续研究的第一步，预计将导致开发出满足艾滋病毒感染妇女的特定性别、心理和医疗需求的疗法，以提高对抗逆转录病毒治疗的依从性和护理的保留率。本申请中提出的研究具有创新性，因为：1）它关注的是未被充分研究的弱势群体，即居住在南方腹地的艾滋病毒感染妇女，这些妇女已被证明在经济上处于不利地位，并且患有高抑郁症​​； 2) 计划在文化上调整干预措施，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依从性；3) 使用远程医疗技术，这将解决获得护理和心理健康服务的障碍。

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.