Measurement-based care for depression in resource-poor settings

描述(申请人提供)：精神健康合并症在艾滋病毒感染人群中很常见，抑郁症往往是最普遍和被高度忽视的，尽管有证据表明，抑郁症对坚持抗逆转录病毒治疗(ART)、认知和免疫功能以及危险行为有不利影响。在全世界大多数艾滋病毒临床护理中，减少不良后果和不必要的抑郁症的衡量、监测和支持严重不足，在低收入和中等收入国家往往可以忽略不计。在海地，它基本上是不存在的。在撒哈拉以南非洲之后，世界上受艾滋病毒影响最严重的地区是加勒比地区；50%的艾滋病毒感染者生活在海地，这是低收入国家中最具挑战性和最贫穷的环境之一。有管理的治疗抑郁症的方法，包括算法引导的抗抑郁药物治疗，在普通初级保健人群中显示出有效性，最近在美国对艾滋病毒患者的护理方面也有希望。然而，它们还没有被研究用于LMIC中的辅助人员。如果没有综合的心理社会关怀和支持，在这些国家扩大抗逆转录病毒治疗对流行病的影响将是不可持续的。像海地这样的LMIC提供了一个机会，可以在抗逆转录病毒治疗临床网络的基础上创建类似的精神卫生测量、监测和支持模式，这可以作为一般卫生系统的创新来源。我们建议开展一项研究，以开发和评估在太子港的海天感染机会主义(GHESKIO)中心发起抗逆转录病毒治疗的HIV阳性个人中的辅助驱动抑郁管理模式，该中心负责海地50%的抗逆转录病毒治疗人口。我们提出的方法是基于循证的基于测量的护理(MBC)模型，该模型指导HIV临床工作人员和医生进行基于算法的抗抑郁治疗。我们将进行一项试点，并在一项小型随机临床试验(RCT)中评估可行性和成本。这项拟议的R21发展和探索性研究将在海地产生第一个与抑郁症有关的心理社会因素的系统形成工作，并将第一个在LMIC的ART系统中与辅助人员一起应用和测试MBC方法。

DESCRIPTION (provided by applicant): Mental health comorbidities are common in HIV-infected populations, and depression is frequently the most prevalent and highly neglected despite evidence of is adverse effects on adherence to antiretroviral treatment (ART), cognitive and immunological function, and risky behavior. The measurement, monitoring and support to reduce adverse outcomes and needless suffering from depression is woefully inadequate in most HIV clinical care worldwide, and frequently negligible in low-and-middle income countries (LMICs). In Haiti, it is largely nonexistent. After Sub-Saharan Africa, the most HIV-affected region in the world is the Caribbean; 50% of people with HIV infection live in Haiti, one of the most challenging and deprived environments among LMICs. Managed approaches to depression, including algorithm-guided antidepressant treatment, have shown efficacy in general primary care populations and recent promise in the care of HIV patients in the United States. However, they have not been studied for use with auxiliary personnel in LMICs. Without integrated psychosocial care and support, gains against the epidemic from ART scale up in these countries will not be sustainable. LMICs like Haiti offer an opportunity to build on the ART clinical network to create similar measurement, monitoring and support models in mental health, which can be used as a source of innovation in the general health system. We propose a study to develop and evaluate an auxiliary-driven model of depression management among HIV positive individuals initiating ART at the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) centers in Port-au-Prince, which is responsible for 50% of the ART population in Haiti. Our proposed approach is based on an evidence-based model of measurement-based care (MBC), which guides HIV clinical staff and physicians in algorithm- based antidepressant treatment. We will conduct a pilot and evaluate feasibility and costs in a small randomized clinical trial (RCT). This proposed R21 developmental and exploratory study will produce the first systematic formative work of psychosocial factors related to depression in Haiti, and will be the first to apply and test the MBC approach with auxiliary personnel in an LMIC's ART system.