Treatment for depression and adherence in people living with HIV in Zimbabwe

描述(申请人提供)：津巴布韦艾滋病毒携带者改善抑郁和坚持抗逆转录病毒治疗的治疗(Tendai)在津巴布韦成年人口中，目前有350,000人有资格接受抗逆转录病毒治疗，到2015年，这一数字上升到500,000人(联合国艾滋病规划署，2010年)。抑郁症在艾滋病毒携带者中造成了相当大的额外疾病负担。然而，目前还没有在非洲艾滋病毒携带者中进行抑郁症治疗的试验。纵向研究表明，基线抑郁与HIV疾病结局之间存在关联，包括HIV疾病进展、对抗逆转录病毒治疗的依从性差以及死亡率。在非洲，缺乏关于文化上适当和有效的治疗模式的证据是治疗PLWH抑郁症的障碍。这项提议的第一个目的是在津巴布韦的一家抗逆转录病毒治疗处方设施完成治疗抑郁症的综合干预措施，并提高抗逆转录病毒治疗的依从性。为此，我们将进行定性测试，以加深对我们的干预、提供干预的最佳方法及其可能影响的更多了解。第二个目标是进行一项试验性随机对照试验，将这种干预措施与增强型常规护理进行比较，测试未来试验的可行性，并评估综合抑郁依从性干预对抗逆转录病毒依从性、CD4淋巴细胞计数和抑郁症的影响。探索性试验的主要目的是1)测试招募患有抑郁症的PLWH并将其随机纳入抑郁症依从性干预措施的RCT的可行性2)使用每个实践者10%的疗程的音频记录来监测干预的实施情况3)测试在3个月和6个月随访并将辍学降至最低的方法4)为未来的主要试验确定比较组和5)收集数据以允许对干预的效果进行估计，从而为主要试验所需的样本提供信息。我们将通过津巴布韦的研究人员与来自英国、美国和南非的外部教师之间充满活力的合作伙伴关系来开展这项研究。该组织内部的伙伴关系已经很牢固，包括在PEPFAR/NIH资助的津巴布韦大学健康科学学院医学教育伙伴倡议(MEPI)奖上的合作。能力建设将在整个拟议研究期间进行，在津巴布韦提供短期课程，由心理健康、艾滋病毒的神经认知方面和心理学与健康交叉的综合干预领域的专家讲授，并通过与精神病学研究所和英国布里斯托尔大学、哈佛医学院和开普敦大学的合作伙伴进行面对面和远程指导来进行‘边做边学’。该伙伴关系将共同努力，进一步确定研究领域并实施试点研究。

DESCRIPTION (provided by applicant): Treatment to improve depression and adherence to antiretroviral therapy in people living with HIV in Zimbabwe (TENDAI) Among the Zimbabwe adult population, 350,000 are currently eligible for ART, a figure rising to 500,000 by 2015 (UNAIDS 2010). Depression causes considerable added disease burden among people living with HIV. However there have been no trials of depression treatment among people living with HIV in Africa. Longitudinal studies show an association between depression at baseline and HIV disease outcomes including HIV disease progression, poor adherence to antiretroviral therapy, and mortality. Lack of evidence on culturally appropriate and effective treatment models is a barrier in treating depression in PLWH in Africa. The first aim of this proposal is to finalize an integrated intervention to treat depression and improve adherence to antiretroviral therapy in an antiretroviral therapy prescribing facility in Zimbabwe. To do this we will carry out qualitative testing to develop more understanding of our intervention, of the best method of delivering it, and of its possible effects. The second aim is conduct a pilot randomized controlled trial of this intervention compared to enhanced usual care, to test the feasibility for a future trial and to estimate the effect of the integrated depression-adherence intervention on antiretroviral adherence, CD4 lymphocyte count, and depression. The main aims of the exploratory trial are 1) to test the feasibility of recruiting and randomising PLWH with co-morbid depression into an RCT of the depression- adherence intervention 2) to monitor the delivery of the intervention using audio recording of 10% of sessions for each practitioner 3) to test ways of following up and minimizing drop out at 3 and 6 months 4) to determine a comparison arm for a future main trial and 5) to gather data to allow estimates to be made of the effect of the intervention to inform the sample required for a main trial. We will carry out the research through our dynamic collaborative partnership between researchers in Zimbabwe and outside faculty from the UK, US, and South Africa. Partnerships within the group are already strong, including collaboration over the PEPFAR/NIH-funded Medical Education Partnership Initiative (MEPI) award to the University of Zimbabwe College of Health Sciences. Capacity building will take place throughout the proposed study providing short courses in Zimbabwe taught by experts in the fields of research methods in mental health, in neurocognitive aspects of HIV and in integrated interventions at the intersection of psychology and health, and through 'learning by doing' with face-to-face and distance mentoring by partners from the Institute of Psychiatry and Bristol University UK, from Harvard Medical School and from the University of Cape Town. The partnership will work together to further define the research area and implement pilot studies.