Measurement-based care for depression in resource-poor settings

资源匮乏地区基于测量的抑郁症护理

• 批准号: 8659819
• 负责人: JESSY G DEVIEUX
• 金额: $ 17.18万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-03 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8659819
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Adult; Adverse effects; Affect; Africa; Africa South of the Sahara; Algorithms; Anti-Retroviral Agents; Antidepressive Agents; Attention; Behavior; Caribbean region; Caring; Clinic; Clinical; Clinical Treatment; Clinical Trials Unit; Cognitive; Communities; Comorbidity; Country; Data; Depressed mood; Development; Diagnosis; Disease remission; Environment; Epidemic; Evaluation; Exploratory/Developmental Grant; Failure; Future; HIV; HIV Infections; HIV Seropositivity; Haiti; Health; Health Personnel; Health system; Human Resources; Income; Individual; Infection; Intervention; Left; Life; Major Depressive Disorder; Measurement; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Monitor; Nurses; Patients; Pharmaceutical Preparations; Physicians; Population; Primary Health Care; Procedures; Protocols documentation; Psychosocial Assessment and Care; Psychosocial Factor; Randomized; Randomized Clinical Trials; Reporting; Research Infrastructure; Resources; Risk Behaviors; Services; Source; System; Testing; Training; Treatment Cost; Treatment outcome; United States; United States National Institutes of Health; Work; adverse outcome; antiretroviral therapy; base; clinical care; cognitive function; cost; depressive symptoms; evidence base; experience; immune function; improved; innovation; instrument; mortality; neglect; programs; psychosocial; public health relevance; response; satisfaction; scale up; screening; staff intervention; therapy development; treatment adherence; treatment as usual; treatment center; treatment response

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.

描述（由申请人提供）：精神健康合并症在HIV感染人群中很常见，抑郁症通常是最普遍和高度忽视的，尽管有证据表明其对抗逆转录病毒治疗（ART）的依从性、认知和免疫功能以及危险行为有不良影响。在全球大多数艾滋病毒临床护理中，减少抑郁症的不良后果和不必要痛苦的测量，监测和支持远远不够，在低收入和中等收入国家（LMIC）中往往可以忽略不计。在海地，这基本上是不存在的。在撒哈拉以南非洲地区之后，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，这是中低收入国家中最具挑战性和最贫困的环境之一。抑郁症的管理方法，包括算法指导的抗抑郁药治疗，在一般初级保健人群中显示出疗效，最近在美国艾滋病患者的护理中也有希望。然而，还没有研究过在中低收入国家辅助人员中使用这种方法。如果没有综合的心理社会护理和支持，这些国家扩大抗逆转录病毒疗法在防治这一流行病方面取得的成果将无法持续。像海地这样的中低收入国家提供了一个机会，可以在抗逆转录病毒疗法临床网络的基础上建立类似的心理健康测量、监测和支持模式，这些模式可以用作一般卫生系统的创新来源。我们提出了一项研究，以开发和评估抑郁症的管理模式，艾滋病毒阳性的人开始在海地团体d'Etude杜Sarcome德Kaposi等DES感染性腹泻（GHESKIO）中心在太子港，这是负责在海地的ART人口的50%的ART。我们提出的方法是基于循证模型的测量为基础的护理（MBC），指导艾滋病毒临床工作人员和医生在算法为基础的抗抑郁治疗。我们将在一项小型随机临床试验（RCT）中进行试点并评估可行性和成本。这项拟议的R21发展和探索性研究将产生与海地抑郁症相关的心理社会因素的第一个系统的形成工作，并将是第一个应用和测试MBC方法与辅助人员在LMIC的ART系统。