e-SMART/EST HIV Telehealth Intervention
Condition: Hiv; Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      The goal of this project is to adapt an evidence-based, enhanced cognitive-behavioral stress
      management intervention (CSBM+) to target depression among older HIV-positive women in the
      Bronx, New York. The intervention, "Stress Management and Relaxation Training/Expressive
      Supportive Therapy" (SMART/EST), demonstrated effectiveness in numerous iterations over 15+
      years, including trials with racially diverse HIV-positive women. To meet changing community
      needs including moving behavioral interventions to telehealth, we will pilot test
      e-SMART/EST, a teletherapy adaptation with peer support for HIV+ older women.
    

Detailed description: 
      HIV-positive older women are a neglected, high-risk population for depression. Depression is
      the most common psychiatric comorbidity for people living with HIV (PLWH), with prevalence
      between 20-40% and up to 78% in some cohorts. It has associations with lower CD4 (cluster of
      differentiation 4 - a type of white blood cell) count, higher viral load, reduced medication
      adherence, and AIDS-related and all-cause mortality. Among older people living with HIV/AIDS
      (PLWHA), women are more likely than men to be depressed.

      Group teletherapy is an efficacious modality to target depression, including among PLWHA,
      with improved retention and acceptability. To harness these innovations to improve outcomes
      for HIV+ older women, we will incorporate community feedback to refine and test an online
      adaption of SMART/EST, an empirically validated cognitive-behavioral stress
      management/expressive supportive therapy (CBSM+). SMART/EST is effective with HIV+ women and
      will likely be translated online given the proliferation of cognitive-behavioral therapy
      (CBT) teletherapy groups. Results will inform secondary prevention with a growing generation
      of HIV+ older women.

      The original, in-person intervention is a 16-session, two-hour weekly group using CBSM+ to
      target depression, medication adherence, nutrition, physical activity, harm reduction,
      smoking, and safer sex. e-SMART/EST will be online, condensed to 8 weekly 1-hour sessions,
      and will target depression. The study has two phases. In Phase 1, we will obtain scientific,
      community and expert advice from 8 community peer, scientific, and clinical advisors to adapt
      existent protocols. In Phase 2, we will conduct a pragmatic single group pre-post trial with
      10 participants recruited from Montefiore's Women's Interagency HIV Study (WIHS).

      e-SMART/EST will be facilitated on MyChart by a Psychologist (PsyD) with prior experience
      developing the intervention, and co-facilitated by a community peer and Healthy Aging
      Specialist with 25+ years of experience in HIV programming. Participants will complete pre-
      and post-test surveys, as well as provide feedback about feasibility, adaptability, and
      recommendations to improve the intervention. Statistical analyses include paired-samples
      t-tests and adaptability/feasibility tests, as well as measures of fidelity.
    

Intervention name(s): Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)
Intervention type(s): Behavioral
Intervention description(s): Cognitive-behavioral stress management/expressive supportive therapy (CBSM+) group targeting depression
Intervention model: Single Group Assignment
Intervention model description: This clinical trial involves a single treatment arm, consisting of 10 women enrolled in a pilot group. The group will meet weekly for 8 weeks. The intervention consists of cognitive-behavioral stress management/expressive supportive therapy (CBSM+) targeting depression among older women with HIV. The group will be co-facilitated by a Psychologist and a Peer.
Masking: None (Open Label)
Primary purpose: Treatment