Measurement-based care for depression in resource-poor settings

描述（由申请人提供）：精神健康合并症在艾滋病毒感染人群中很常见，尽管有证据表明抑郁症对坚持抗逆转录病毒治疗（ART）、认知和免疫功能以及危险行为产生不利影响，但抑郁症往往是最普遍和最容易被忽视的。在世界上大多数艾滋病毒临床护理中，减少不良后果和不必要的抑郁症痛苦的测量、监测和支持严重不足，在低收入和中等收入国家往往可以忽略不计。在海地，基本不存在。在撒哈拉以南非洲之后，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。治疗抑郁症的管理方法，包括算法指导的抗抑郁治疗，已经在普通初级保健人群中显示出疗效，最近在美国对艾滋病患者的治疗中也有希望。然而，还没有研究它们在中低收入国家辅助人员中的使用情况。如果没有综合的心理社会护理和支持，这些国家通过抗逆转录病毒治疗取得的防治艾滋病的成果将无法持续。像海地这样的低收入和中等收入国家提供了一个机会，可以在抗逆转录病毒治疗临床网络的基础上，在精神卫生方面创建类似的测量、监测和支持模式，这可以作为一般卫生系统创新的一个来源。我们提出了一项研究，以开发和评估在太子港的海地研究小组（GHESKIO）中心启动抗逆转录病毒治疗的艾滋病毒阳性个体的抑郁管理辅助驱动模型，该中心负责海地50%的抗逆转录病毒治疗人口。我们提出的方法是基于基于测量的护理（MBC）的循证模型，该模型指导HIV临床工作人员和医生进行基于算法的抗抑郁治疗。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海地抑郁症相关心理社会因素的第一个系统形成工作，并将首次在低收入和中等收入国家的抗逆转录病毒治疗系统中与辅助人员应用和测试MBC方法。

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.