Effects of Depression and Its Treatment on the Impact of ART on Health Outcomes

说明(由申请人提供)：扩大获得抗逆转录病毒治疗的机会有可能极大地惠及个人和家庭的身体、社会和经济福祉，并会产生意想不到的负面后果，即增加危险行为和可能损害其有效性的社会破坏。利用社会认知理论，这项拟议的为期4年的研究将考察(1)抑郁症如何直接影响患者及其家庭的多种健康结果，包括经济产出、家庭布局、儿童入学情况和性危险行为，并作为ART影响的调节因素；(2)在乌干达ART推广的背景下，抗抑郁治疗在减轻抑郁对这些健康结果的负面影响方面的影响。这项研究将分为两个阶段。在第一阶段，对抗逆转录病毒治疗患者、诊所提供者、管理者和支持服务机构的半结构化定性访谈将被用来探讨(1)艾滋病毒和抗逆转录病毒疗法对患者的身心健康、社会、经济和性健康的影响；(2)精神健康和抑郁如何影响抗逆转录病毒疗法的结果；以及(3)对抑郁症治疗和抗抑郁药物的态度和可接受性。这些发现将有助于开发和完善第二阶段使用的假设和措施。在第二阶段，进入艾滋病毒护理并开始抗逆转录病毒治疗的患者将在一项纵向前瞻性队列研究中接受为期12个月的跟踪。那些被诊断为抑郁症的人将接受抗抑郁治疗。我们在乌干达对抗逆转录病毒治疗和非抗逆转录病毒治疗患者进行的另外两项观察性队列研究的数据，包括一组患有抑郁症但没有接受抑郁症治疗的患者，将为评估抑郁症和抗抑郁治疗的效果提供重要的额外比较数据。这些调查结果可为制定干预措施和公共卫生政策提供重要信息，这些政策旨在最大限度地发挥抗逆转录病毒疗法在限制艾滋病毒传播方面的益处，以及该流行病在发展中国家的社会和经济后果，包括优先改善抑郁症的诊断和治疗。公共卫生相关性：这项研究对公共卫生很重要，因为它的研究结果可以为制定干预措施和公共卫生政策提供关键信息，这些干预措施和公共卫生政策旨在最大限度地发挥抗逆转录病毒疗法在限制艾滋病毒传播方面的好处以及该流行病在发展中国家的社会和经济后果，包括优先考虑改善抑郁症的诊断和治疗。

DESCRIPTION (provided by applicant): The expansion of access to ART has the potential to greatly benefit the physical, social and economic well being of individuals and households, as well as produce unintended negative consequences with regard to increased risk behavior and social disruption which can compromise its effectiveness. Drawing on Social Cognitive Theory, the proposed 4-year study will examine (1) how depression influences multiple health outcomes of patients and their households including economic output, household constellation, children's school attendance, and sexual risk behaviors, both directly and as a moderator of impact of ART; and (2) the impact of antidepressant treatment in mitigating the negative consequences of depression on these health outcomes in the context of ART scale-up in Uganda. The study will consist of two phases. In Phase 1, semi- structured qualitative interviews with ART patients, clinic providers, administrators, and support service organizations will be used to explore (1) the impact of HIV and ART on patients' physical, mental, social, economic and sexual health; (2) how mental health and depression influence these ART outcomes; and (3) attitudes towards and acceptability of depression treatment and antidepressants. Findings will help develop and refine hypotheses and measures for use in Phase 2. In Phase 2, patients entering HIV care and starting ART will be followed for 12 months in a longitudinal prospective cohort study. Those diagnosed with depression will be offered antidepressant treatment. Data from our two other just-funded observational cohort studies of ART and non-ART patients in Uganda, which include a subgroup of patients who are depressed but not receiving depression treatment, will provide important additional comparative data for evaluating the effects of depression and antidepressant therapy. These findings could provide critical information for the development of interventions and public health policy aimed at maximizing the benefits of ART in limiting HIV transmission and the social and economic consequences of the epidemic in the developing world, including the prioritization of improved diagnosis and treatment of depression. PUBLIC HEALTH RELEVANCE: This study is important to public health as its findings could provide critical information for the development of interventions and public health policy aimed at maximizing the benefits of ART in limiting HIV transmission and the social and economic consequences of the epidemic in the developing world, including the prioritization of improved diagnosis and treatment of depression.