Trial of Collaborative Depression Care Management for HIV Patients
Condition: Depression; HIV
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This project will integrate a depression treatment and brief medication adherence counseling
      intervention into clinical care at three HIV clinics and will use a randomized controlled
      trial to assess whether, relative to usual care, the intervention leads to improved HIV
      medication adherence. The depression treatment intervention uses a model known as
      Measurement-Based Care which equips Depression Care Managers with systematic measurement
      tools, a decision algorithm, and psychiatric backup and trains them to provide decision
      support to HIV clinicians to implement, monitor, and adjust antidepressant therapy.
    

Detailed description: 
      Our goal in this project is to conduct a randomized controlled trial of an evidence-based
      depression treatment intervention known as Measurement-Based Care (MBC), combined with brief
      Motivational Interviewing (MI) adherence counseling, in depressed people living with HIV/AIDS
      to assess its impact on ART adherence and clinical outcomes. MBC employs Depression Care
      Managers with expertise in depression management to screen for depression and help
      non-psychiatric physicians implement guideline-concordant, algorithm-driven antidepressant
      treatment. The Depression Care Manager use standardized metrics (depressive symptoms, side
      effects) and an algorithm to monitor treatment response and recommend changes. Weekly
      supervision from a psychiatrist ensures quality care. Biweekly contact between patients and
      the Depression Care Manager will include brief MI adherence counseling.

      We will recruit 390 people living with HIV/AIDS on antiretroviral therapy (ART) with
      confirmed depression, and will conduct a randomized trial of the MBC intervention versus
      enhanced usual care. Our aims are: (1) to test whether MBC improves ART adherence and HIV
      clinical outcomes, (2) to assess the cost-effectiveness of MBC, and (3) to collect process
      measures concerning MBC implementation to inform replication at other sites. Since the
      Depression Care Manager role can be effectively filled by a behavioral health provider or
      nurse given appropriate training and supervision and the intervention has limited time
      requirements, this model is potentially replicable to a wide range of resource-constrained
      HIV treatment settings.
    

Intervention name(s): Measurement-Based Care collaborative depression management; Enhanced Usual Care
Intervention type(s): Other; Other
Intervention description(s): Depression Care Manager collects metrics on depressive severity and side effects and provides decision support regarding antidepressant initiation and modification to HIV providers who prescribe medications
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Depression; HIV; Adherence; Collaborative care; Measurement-Based Care