Adaptation of a Depression Treatment Intervention for HIV Patients in Cameroon

喀麦隆艾滋病毒患者抑郁症治疗干预措施的调整

• 批准号: 7897673
• 负责人: BRADLEY N GAYNES
• 金额: $ 20.07万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-21 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7897673
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adverse effects; Affect; Africa South of the Sahara; African; Aftercare; Algorithms; Anti-Retroviral Agents; Antidepressive Agents; Anxiety Disorders; Area; Arts; Behavior; Behavioral; Biological Process; CD4 Lymphocyte Count; Cameroon; Caring; Case Manager; Characteristics; Chronic; Clinic; Clinic Visits; Clinical; Clinical Management; Communicable Disease Control; Comorbidity; Consult; Controlled Study; Country; DSM-IV; Data; Depressed mood; Depression screen; Development; Diagnostic; Discipline of Nursing; Disease; Disease remission; Dose; Drug Interactions; Drug resistance; Effectiveness; Elements; Failure; Focus Groups; Funding; Gender; General Population; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Personnel; Home environment; Immune system; Individual; International; Intervention; Interview; Knowledge; Laboratories; Lead; Link; Logistics; Low income; Maintenance; Major Depressive Disorder; Measurement; Measures; Medical; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Modification; Monitor; Moods; Morbidity - disease rate; Neurologist; North Carolina; Nurse Psychotherapist; Nurses; Nursing Staff; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Physician Assistants; Physicians; Plasma; Population; Prevalence Study; Prevention; Primary Care Physician; Primary Health Care; Process; Protocols documentation; Provider; Psychiatric Nursing; Questionnaires; RNA; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Recruitment Activity; Reference Standards; Regimen; Relative (related person); Reporting; Research; Research Infrastructure; Research Personnel; Resources; Risk; Rural; Sampling; Schedule; Services; Severities; Site; Source; Specialist; Specimen; Staging; Suggestion; Symptoms; Talents; Telephone; Testing; Time; Training; Treatment Protocols; United States; Universities; Validity and Reliability; Viral Load result; Work; World Health Organization; antiretroviral therapy; base; behavioral health; clinical care; cohort; cost; cost effectiveness; depressive symptoms; design; evidence base; experience; improved; innovation; instrument; literate; medication compliance; mortality; nursing intervention; patient population; prevent; primary care setting; programs; residence; response; sex risk; success; therapy adherence; tool; treatment planning; treatment program; trend; validation studies

DESCRIPTION (provided by applicant): Mental illness is a serious concern in the clinical management of HIV infection. In the United States, mood and anxiety disorders affect up to half of HIV+ patients. HIV+ individuals in resource-poor countries have similarly elevated rates of mental illnesses. Depression has been linked to a range of negative HIV-related behavioral and clinical health outcomes, including more sexual risk behaviors, worse antiretroviral therapy (ART) adherence, poor response to ART, faster immune system decline, and higher mortality. Approaches known as "Measurement-Based Care" (MBC) integrated into primary care settings have effectively addressed comorbid depression in non-HIV patient populations. Multisite randomized clinical trials have demonstrated the efficacy of MBC models, which employ clinical coordinators with depression expertise to help physicians implement guideline-concordant, algorithm-driven antidepressant treatment. The development of effective, culturally appropriate mental health interventions for HIV patients is particularly time-critical in sub-Saharan Africa (SSA), home to nearly two-thirds of the estimated 33 million people infected with HIV. Combination ART is just starting to become widely available in the region. Successful ART treatment and the prevention of drug resistance hinge on strict medication adherence. As depression is one of the most consistent predictors of poor adherence and has been declared by expert panels to be an important concern in the management of HIV around the world, tested interventions to address mental health issues in African HIV clinical settings are sorely needed. In the present R34 application, we propose to assess the feasibility and acceptability of implementing a randomized controlled trial (RCT) of an MBC depression management program that is primarily staffed by nurses and integrated into HIV clinical care sites. Project activities will take place in the English-speaking region of Cameroon due to the long-standing collaborative relationship between the University of North Carolina-Chapel Hill Center for AIDS Research and the Center for the Study and Control of Communicable Diseases of the University of Yaound¿ in Yaound¿, Cameroon. Our specific aims are to (1) Establish the validity, reliability, and cultural appropriateness of a case identification protocol to identify patients with major depressive disorder (MDD) at a semi-urban HIV clinical care site in English-speaking Cameroon; (2) Adapt an MBC treatment intervention for patients with MDD to the context of HIV treatment in Cameroon, and train HIV providers and nurses in implementing the intervention; and (3) Evaluate the feasibility of recruiting and retaining patients from our partnering clinic and collecting and processing laboratory specimens. Should our intervention prove feasible and demonstrate evidence of potential effectiveness, we will compete for R01 funding. This subsequent funding would permit us to implement an RCT of the effect of this depression identification and treatment protocol on ART adherence, HIV clinical indicators, and mental health outcomes.

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