Treatment for depression and adherence in people living with HIV in Zimbabwe

描述（由申请人提供）：津巴布韦艾滋病毒感染者改善抑郁症和坚持抗逆转录病毒治疗的治疗（TENDAI）在津巴布韦成年人口中，目前有35万人有资格接受抗逆转录病毒治疗，到2015年这一数字将上升到50万（联合国艾滋病规划署，2010年）。抑郁症对艾滋病毒感染者造成相当大的额外疾病负担。然而，目前还没有在非洲艾滋病病毒感染者中进行抑郁症治疗的试验。纵向研究显示，基线抑郁与HIV疾病结局（包括HIV疾病进展、抗逆转录病毒治疗依从性差和死亡率）之间存在关联。缺乏文化上适当和有效的治疗模式的证据是非洲PLWH治疗抑郁症的一个障碍。这项建议的第一个目标是最终确定一项综合干预措施，以治疗抑郁症，并改善津巴布韦抗逆转录病毒治疗处方机构对抗逆转录病毒治疗的依从性。为此，我们将进行定性测试，以进一步了解我们的干预措施、提供干预措施的最佳方法及其可能产生的效果。第二个目的是进行一项随机对照试验，将这种干预与增强的常规护理进行比较，以测试未来试验的可行性，并评估抑郁-依从性综合干预对抗逆转录病毒依从性、CD4淋巴细胞计数和抑郁的影响。探索性试验的主要目的是测试1)招聘和随机试验的可行性抑郁共病性抑郁的一个随机对照试验的PLWH -依从性干预2)监控交付10%的会话的干预使用录音为每个从业者3)测试跟踪和最小化的方式退出3和6个月4)来确定一个比较臂为未来主要试验和5)收集数据,允许估计的影响干预以告知主要试验所需的样本。我们将通过我们在津巴布韦的研究人员和来自英国、美国和南非的外部教师之间的动态合作伙伴关系进行研究。该组织内部的伙伴关系已经很强大，包括在向津巴布韦大学健康科学学院颁发PEPFAR/ nih资助的医学教育伙伴关系倡议（MEPI）奖方面的合作。能力建设将贯穿拟议的研究，在津巴布韦提供短期课程，由心理健康、艾滋病毒的神经认知方面的研究方法以及心理学与健康交叉领域的综合干预措施方面的专家授课，并通过精神病学研究所和英国布里斯托尔大学、哈佛医学院和开普敦大学的合作伙伴进行面对面和远程指导的“边做边学”。该伙伴关系将共同努力，进一步确定研究领域并实施试点研究。

DESCRIPTION (provided by applicant): Treatment to improve depression and adherence to antiretroviral therapy in people living with HIV in Zimbabwe (TENDAI) Among the Zimbabwe adult population, 350,000 are currently eligible for ART, a figure rising to 500,000 by 2015 (UNAIDS 2010). Depression causes considerable added disease burden among people living with HIV. However there have been no trials of depression treatment among people living with HIV in Africa. Longitudinal studies show an association between depression at baseline and HIV disease outcomes including HIV disease progression, poor adherence to antiretroviral therapy, and mortality. Lack of evidence on culturally appropriate and effective treatment models is a barrier in treating depression in PLWH in Africa. The first aim of this proposal is to finalize an integrated intervention to treat depression and improve adherence to antiretroviral therapy in an antiretroviral therapy prescribing facility in Zimbabwe. To do this we will carry out qualitative testing to develop more understanding of our intervention, of the best method of delivering it, and of its possible effects. The second aim is conduct a pilot randomized controlled trial of this intervention compared to enhanced usual care, to test the feasibility for a future trial and to estimate the effect of the integrated depression-adherence intervention on antiretroviral adherence, CD4 lymphocyte count, and depression. The main aims of the exploratory trial are 1) to test the feasibility of recruiting and randomising PLWH with co-morbid depression into an RCT of the depression- adherence intervention 2) to monitor the delivery of the intervention using audio recording of 10% of sessions for each practitioner 3) to test ways of following up and minimizing drop out at 3 and 6 months 4) to determine a comparison arm for a future main trial and 5) to gather data to allow estimates to be made of the effect of the intervention to inform the sample required for a main trial. We will carry out the research through our dynamic collaborative partnership between researchers in Zimbabwe and outside faculty from the UK, US, and South Africa. Partnerships within the group are already strong, including collaboration over the PEPFAR/NIH-funded Medical Education Partnership Initiative (MEPI) award to the University of Zimbabwe College of Health Sciences. Capacity building will take place throughout the proposed study providing short courses in Zimbabwe taught by experts in the fields of research methods in mental health, in neurocognitive aspects of HIV and in integrated interventions at the intersection of psychology and health, and through 'learning by doing' with face-to-face and distance mentoring by partners from the Institute of Psychiatry and Bristol University UK, from Harvard Medical School and from the University of Cape Town. The partnership will work together to further define the research area and implement pilot studies.