Behavioral Depression Treatment for African American HIV-infected Substance Users

描述(由申请人提供)：大约37-50%的艾滋病毒阳性个人患有抑郁症，这与药物使用、对艾滋病毒药物的不良坚持、艾滋病毒危险行为的增加以及随后的不良健康结果有关(例如，Asch等人，2003；Bing等人，2001；Dew等人，1997；Johnson，Rabkin，Lipsitz，Williams和Rhemen，1999)。此外，抑郁的艾滋病毒阳性物质使用者比非物质使用者更容易出现服药依从性差的风险(Cook，Grey，&Burke-Miller，2004)。值得注意的是，证据表明，接受抑郁症治疗的艾滋病毒阳性患者在遵守艾滋病毒药物治疗方面有显著改善，并减少了与他们的健康和福祉直接相关的危险行为，如危险的性行为(例如，Cook等人，2006年)。尽管有这种联系，但针对抑郁症的干预措施很少被开发出来，以满足艾滋病毒感染药物使用者的特定需求。对于低收入的非裔美国人艾滋病毒阳性药物使用者来说，这一点尤其明显，他们往往由于贫困、缺乏获得专门治疗的机会、动力不足、认知障碍以及医疗、精神健康和药物滥用治疗提供者之间缺乏协调而没有得到适当治疗(Calsyn等人，2004年)。因此，本提案的目标是测试一种新的行为方法，以治疗抑郁症状，并改善居住在华盛顿特区市中心的170名非裔美国人艾滋病毒感染物质使用者的艾滋病毒用药依从性和随后的身体健康结果。这种治疗方法结合了(1)let‘s ACT，这是一种针对抑郁药物使用者(Daughters，Braun，Sargeant，Hopko，Blanco和Lejuez，正在出版中)的基于行为激活的治疗方法，(2)Life Steps，一种HIV药物依从性干预(Safren，Otto，&Worth，1999)。这种联合治疗(即ACT Healthy；见附录的初步治疗师和患者手册)的目的将是补充标准的住宅和后续门诊物质使用治疗，以专门治疗抑郁症状，额外的目标是改善艾滋病毒用药依从性、物质使用和身体健康结果。170名HIV阳性、抑郁症状加重的少数族裔药物使用者将被随机分配到常规治疗+ACT Healthy或TAU+非指令疗法，以测试ACT Healthy的疗效。两组的治疗都是照常进行，包括标准的住院和门诊药物滥用治疗。根据这项初步试验的结果，ACT健康方案将进一步完善，并为更大规模的临床试验做好准备。 公共卫生相关性本提案的目的是测试一种新的行为方法，以治疗抑郁症状，并改善居住在华盛顿特区市中心的非裔美国人艾滋病毒感染物质使用者对艾滋病毒药物的依从性和随后的身体健康结果。这一治疗将作为标准住宅和后续门诊药物使用治疗的补充，目的是减少抑郁症状，改善艾滋病毒用药依从性、身体健康和药物使用结果。从更长期的角度来看，这笔赠款将为更多的大规模测试奠定基础，以确定其作为一种专门、有效的治疗方法的效用，用于治疗具有抑郁症状、艾滋病毒药物依从性和复发性药物使用困难的风险最高的重要亚群，因此在减少艾滋病毒传播方面将具有重要的临床和公共卫生意义。

DESCRIPTION (provided by applicant): Approximately 37-50% of HIV positive individuals suffer from depression, which is associated with substance use, poor adherence to HIV medication, an increase in HIV risk behaviors, and subsequent poor health outcomes (e.g., Asch et al., 2003; Bing et al., 2001; Dew et al., 1997; Johnson, Rabkin, Lipsitz, Williams, & Remien, 1999). Additionally, depressed HIV positive substance users are at an even greater risk for poor medication adherence than non-substance users (Cook, Grey, & Burke-Miller, 2004). Notably, evidence indicates that HIV positive patients who receive treatment for depression exhibit significant improvements in HIV medication adherence and a reduction in risk behaviors that are directly relevant to their health and well being such as risky sexual behavior (e.g., Cook et al., 2006). Despite this link, few interventions targeting depression have been developed to meet the specific needs of HIV-infected substance users. This is especially evident for low income African American HIV positive substance users who often do not receive adequate treatment for any of these conditions due to poverty, lack of access to specialized treatment, low motivation, cognitive impairments, and a lack of coordination between medical, mental health, and substance abuse treatment providers (Calsyn et al., 2004). Thus, the objective of the present proposal is to test a novel, behavioral approach to treat depressive symptoms and improve HIV medication adherence and subsequent physical health outcomes among 170 African American HIV infected substance users residing in inner-city Washington, DC. This treatment combines (1) LET'S ACT, a behavioral activation based treatment for depressed substance users (Daughters, Braun, Sargeant, Hopko, Blanco, & Lejuez, in press), with (2) Life Steps, an HIV medication adherence intervention (Safren, Otto, & Worth, 1999). The purpose of this combined treatment (i.e., ACT HEALTHY; see Appendix for the preliminary therapist and patient manuals), will be to compliment standard residential and follow-up outpatient substance use treatment to specifically treat depressive symptoms with the additional goal of improving HIV medication adherence, substance use, and physical health outcomes. One hundred and seventy HIV positive minority substance users with elevated depressive symptoms will be randomly assigned to either treatment as usual (TAU) plus ACT HEALTHY or TAU plus Nondirective Therapy to test the efficacy of ACT HEALTHY. Treatment as usual for both groups consists of standard residential and outpatient substance abuse treatment. Based on the outcome of this preliminary trial, the ACT HEALTHY protocol will be further refined and readied for larger-scale clinical trials. PUBLIC HEALTH RELEVANCE The objective of the present proposal is to test a novel, behavioral approach to treat depressive symptoms and improve HIV medication adherence and subsequent physical health outcomes among African American HIV infected substance users residing in inner-city Washington, DC. This treatment will serve as a compliment to standard residential and follow-up outpatient substance use treatment, with the goal of reducing depressive symptoms and improving HIV medication adherence, physical health, and substance use outcomes. From a longer term perspective, this grant will set the stage for more large-scale testing to determine its utility as a specialized, efficacious treatment for a significant subpopulation at greatest risk for difficulties with depressive symptoms, HIV medication adherence, and relapse to substance use, and will therefore have important clinical and public health significance in reducing HIV transmission.