Behavioral Depression Treatment for African American HIV-infected Substance Users
Condition: Depression; Substance Use
MeSH terms: Substance-Related Disorders; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The objective of the current study 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.
    

Detailed description: 
      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 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, 2008), with (2) Life Steps, an HIV medication
      adherence intervention (Safren, Otto, & Worth, 1999). The purpose of this combined treatment
      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. Participants 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.
    

Intervention name(s): ACT HEALTHY; Nondirective Therapy (NDT)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): ACT HEALTHY is based on the empirically validated Behavioral Activation Treatment for Depression (BAT-D; Lejuez, Hopko, & Hopko, 2001) and Life Steps, an HIV medication adherence intervention (Safren, Otto, & Worth, 1999). ACT HEALTHY is based on the belief that the best way to improve mood, remain sober, increase medication adherence, and make long-term life changes is by changing and increasing one's activity level. Treatment includes 16 individual sessions over a 12-week period.; In NDT, the therapist will create an accepting, nonjudgmental, empathic environment to continuously direct client attention to primary feelings, and to facilitate accepting of affective experience using supportive statements, reflective listening, and empathic communications. In addition, medication adherence is addressed with the Life Steps HIV medication adherence intervention (Safren, Otto, & Worth, 1999). Treatment includes 16 individual sessions over a 12-week period.
Other intervention name(s): LETS ACT; Behavioral Activation; Life Steps; Supportive Counseling; Life Steps
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Depression; Substance Use; HIV Medication Adherence; Behavioral Activation