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Nurse-Delivered CBT for Depression-Adherence in HIV Primary Care S. Africa

护士为南非艾滋病毒初级保健中的抑郁症依从性提供 CBT

基本信息

批准号：
9127808
负责人：
Conall Michael O'Cleirigh
金额：
$ 59.73万
依托单位：
UNIVERSITY OF MIAMI CORAL GABLES
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-15 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9127808
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Africa African Alcohol or Other Drugs use Antidepressive Agents Behavior Blinded CD4 Positive T Lymphocytes Caring Cell Count Cessation of life Chronic Clinic Clinical Clinical Psychology Cognitive Therapy Collaborations Communities Comorbidity Cost Effectiveness Analysis Counseling Country Data Depressed mood Development Distress Doctor of Philosophy Drug resistance Effectiveness Electronics Ensure Evidence based intervention Failure Feeling Guidelines HIV HIV Infections Health Health Personnel Healthcare Healthcare Systems Individual Intervention Life Location Major Depressive Disorder Mediating Mental Depression Mental Health Meta-Analysis Modeling Monitor Mood Disorders Nurse Administrator Nurses Office Nursing Outcome Participant Patients Pharmaceutical Preparations Population Prevention strategy Primary Health Care Psychologist Public Health Qualitative Research Quality of life Randomized Regimen Research Research Personnel Resources Self Care Services South Africa South African Students Testing Time Training Treatment Failure Treatment Protocols Treatment outcome Viral Load result Wireless Technology Work antiretroviral therapy arm base bilingualism cost cost effectiveness demographics depressive symptoms design effectiveness trial efficacy trial improved interest meetings neglect pandemic disease pill pilot trial primary care setting primary outcome programs standard of care success therapy adherence treatment as usual treatment effect treatment program treatment strategy uptake

项目摘要

DESCRIPTION (provided by applicant): This is a proposal to conduct a two arm randomized effectiveness trial investigating whether a task shifting/sharing model of treating depression and improving adherence to ART in patients who fail first line antiretroviral therapy (ART) can occur using nurses in South Africa trained in CBT. South Africa is the country with the highest number of HIV infections in the world and the highest number of HIV/AIDS-related deaths,5-7 and where access to third line ART treatment is not currently available in the public healthcare system. Clinical depression, like elsewhere, is one of the highest comorbidities to HIV/AIDS, with estimated rates up to 34.9 percent.8 Depression, in the context of HIV, leads to poor self-care behavior such as non-adherence to ART and worse retention in care, which are critical for treatment success.9 Preliminary work. The U.S. based investigators have developed and successfully tested an approach integrating adherence counseling into cognitive- behavioral therapy for depression in HIV.10,11 The South. Africa based team, in collaboration with the U.S. based team, has conducted preliminary work to evaluate the cultural appropriateness and feasibility of integrating this approach into the South African HIV treatment setting. Accordingly, we have 1) conducted an open-pilot of the treatment in Cape Town with 6 HIV-infected patients with depression using a clinical psychology PhD student as the therapist, 2) conducted formative qualitative research on the manifestation of depression and ways to adapt this approach for the South Africa HIV care setting,12 3) successfully trained two clinic nurses in the adapted version of the intervention, and 4) completed an open pilot feasibility trial with 14 patients with these nurses as interventionists. Design: The current study builds on our successful feasibility pilot. Given that CBT is a validated treatment for depression, and that dissemination of evidenced-based interventions in HIV is a noted priority,13,14 we propose a two-arm effectiveness RCT (stratified by antidepressant medication initiation/use or not) of nurse-delivered cognitive behavioral therapy for depression and adherence integrated into the HIV primary care setting in S. Africa. To ensure that those who need this intervention the most will receive it, participants will be patients with HIV who have failed first line ART, and have a unipolar depressive mood disorder. Primary outcomes (Aim 1) include adherence to ART (assessed by WisePill), depression (assessed by an independent evaluator), and proportion of (second line) treatment failures in each condition. Comparing this integrated care model to usual care (enhanced adherence counseling for first-line treatment-failures in this setting), will allow for an incremental cost-effectiveness analysis in Aim 2. We will collect resource utilization and cost data to examine the cost- effectiveness of reduced depression, and potentially, better HIV outcomes. Before study start-up, and twice a year, we will convene community advisory meetings of HIV patients as well as stakeholders (clinic directors, Nurses AIDS service NGO leaders) to maximize the chances of uptake scalability of the model should it be successful.