Dataset Information

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

ABSTRACT:

Background

Depression is a major barrier to HIV treatment outcomes.

Objective

To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity.

Design

Pseudo-cluster randomized trial.

Setting

Four US infectious diseases clinics.

Participants

HIV-infected adults with major depressive disorder.

Intervention

Measurement-based care (MBC) - depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations.

Measurements

Primary - antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12 months). Primary time-point - 6 months. Secondary - depressive severity, depression remission, depression-free days, measured quarterly for 12 months.

Results

From 2010 to 2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly men, Black, non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care [mean difference -3.7, 95% confidence interval (CI) -5.6, -1.7], probability of depression remission was higher [risk difference 13%, 95% CI 1%, 25%), and suicidal ideation was lower (risk difference -18%, 95% CI -30%, -6%). By 12 months, the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1-57) more depression-free days over 12 months.

Conclusion

In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.

SUBMITTER: Pence BW

PROVIDER: S-EPMC4669218 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Publications

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

Pence Brian W BW Gaynes Bradley N BN Adams Julie L JL Thielman Nathan M NM Heine Amy D AD Mugavero Michael J MJ McGuinness Teena T Raper James L JL Willig James H JH Shirey Kristen G KG Ogle Michelle M Turner Elizabeth L EL Quinlivan E Byrd EB

AIDS (London, England) 20150901 15

<h4>Background</h4>Depression is a major barrier to HIV treatment outcomes.<h4>Objective</h4>To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity.<h4>Design</h4>Pseudo-cluster randomized trial.<h4>Setting</h4>Four US infectious diseases clinics.<h4>Participants</h4>HIV-infected adults with major depressive disorder.<h4>Intervention</h4>Measurement-based care (MBC) - depression care managers used systematic ...[more]

PMID: 26134881

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Dataset Information

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

Background

Objective

Design

Setting

Participants

Intervention

Measurements

Results

Conclusion

Publications

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

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