Behavioral Depression Treatment for African American HIV-infected Substance Users

描述（由申请人提供）：大约37-50%的HIV阳性个体患有抑郁症，这与药物使用、HIV药物依从性差、HIV风险行为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, & Remien, 1999）。此外，抑郁的HIV阳性药物使用者比非药物使用者更容易出现药物依从性差的情况（Cook, Grey, & Burke-Miller, 2004）。值得注意的是，有证据表明，接受抑郁症治疗的艾滋病毒阳性患者在艾滋病毒药物依从性方面表现出显著改善，并减少了与其健康和福祉直接相关的风险行为，如危险的性行为（例如，Cook等人，2006年）。尽管存在这种联系，但很少有针对抑郁症的干预措施被开发出来，以满足感染艾滋病毒的药物使用者的具体需求。对于低收入的非洲裔美国人艾滋病毒阳性药物使用者来说，这一点尤其明显，由于贫困、缺乏获得专门治疗的机会、动机低、认知障碍以及医疗、心理健康和药物滥用治疗提供者之间缺乏协调，这些人往往得不到适当的治疗。因此，本提案的目的是测试一种新的行为方法，以治疗抑郁症状，改善居住在华盛顿特区内城区的170名非洲裔美国人感染艾滋病毒的药物使用者的艾滋病毒药物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，一种基于行为激活的抑郁症药物使用者治疗方法（Daughters, Braun, Sargeant, Hopko, Blanco, & Lejuez，出版中）和(2)Life Steps，一种艾滋病药物依从性干预方法（Safren, Otto, & Worth, 1999）。这种联合治疗的目的（即，ACT健康；见附录初步治疗师和患者手册），将是补充标准的住院和随访门诊药物使用治疗，专门治疗抑郁症状，并提高艾滋病毒药物依从性，药物使用和身体健康结果的额外目标。170名患有抑郁症状升高的HIV阳性少数药物使用者将被随机分配到常规治疗组（TAU）加ACT健康组或TAU加非指导性治疗组，以测试ACT健康组的疗效。两组的常规治疗包括标准的住院治疗和门诊药物滥用治疗。根据这一初步试验的结果，ACT健康方案将进一步完善，并准备进行更大规模的临床试验。

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.