Angela M Bengtson1, Brian W Pence, Bradley N Gaynes, E Byrd Quinlivan, Amy D Heine, Julie K OʼDonnell, Heidi M Crane, W Christopher Mathews, Richard D Moore, Daniel Westreich, Conall OʼCleirigh, Katerina Christopoulos, Matthew J Mimiaga, Michael J Mugavero. 1. Departments of *Epidemiology; †Psychiatry, University of North Carolina, Chapel Hill, NC; ‡Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC; §Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA; ‖Department of Medicine, University of California, San Diego, CA; ¶School of Medicine, Johns Hopkins University, Baltimore, MD; #Department of Psychiatry, Massachusetts General Hospital, Boston, MA; **School of Medicine, University of California, San Francisco, CA; ††Departments of Epidemiology and Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI; ‡‡Institute for Community Health Promotion, Brown University, Providence, RI; §§The Fenway Institute, Fenway Health, Boston, MA; and ‖‖Division of Infectious Diseases, University of Alabama-Birmingham, Birmingham, AL.
Abstract
BACKGROUND: Depression affects 20%-30% of people with HIV. Randomized controlled trials (RCTs) have demonstrated the effectiveness of interventions to improve depression among HIV-infected adults, but typically have highly selected populations which may limit generalizability. Inverse probability of sampling weights (IPSW) is a recently proposed method to transport (or standardize) findings from RCTs to a specific external target population. METHODS: We used IPSW to transport the 6-month effect of the Measurement-Based Care (MBC) intervention on depression from the SLAM DUNC trial to a population of HIV-infected, depressed adults in routine care in the United States between 2010 and 2014. RESULTS: In the RCT, MBC was associated with an improvement in depression at 6 months of 3.6 points on the Hamilton Depression Rating scale [95% confidence interval (CI): -5.9 to -1.3]. When IPSW were used to standardize results from the trial to the target population, the intervention effect was attenuated by 1.2 points (mean improvement 2.4 points; 95% CI: -6.1 to 1.3). CONCLUSIONS: If implemented among HIV-infected, depressed adults in routine care, MBC may be less effective than in the RCT but can still be expected to reduce depression. Attenuation of the intervention effect among adults in routine care reflects the fact that the trial enrolled a larger proportion of individuals for whom the intervention was more effective. Given the burden of depression among HIV-infected adults, more effective interventions to improve depression are urgently needed. However, examining the transportability of trial findings is essential to understand whether similar effects can be expected if interventions are scaled-up.
BACKGROUND:Depression affects 20%-30% of people with HIV. Randomized controlled trials (RCTs) have demonstrated the effectiveness of interventions to improve depression among HIV-infected adults, but typically have highly selected populations which may limit generalizability. Inverse probability of sampling weights (IPSW) is a recently proposed method to transport (or standardize) findings from RCTs to a specific external target population. METHODS: We used IPSW to transport the 6-month effect of the Measurement-Based Care (MBC) intervention on depression from the SLAM DUNC trial to a population of HIV-infected, depressed adults in routine care in the United States between 2010 and 2014. RESULTS: In the RCT, MBC was associated with an improvement in depression at 6 months of 3.6 points on the Hamilton Depression Rating scale [95% confidence interval (CI): -5.9 to -1.3]. When IPSW were used to standardize results from the trial to the target population, the intervention effect was attenuated by 1.2 points (mean improvement 2.4 points; 95% CI: -6.1 to 1.3). CONCLUSIONS: If implemented among HIV-infected, depressed adults in routine care, MBC may be less effective than in the RCT but can still be expected to reduce depression. Attenuation of the intervention effect among adults in routine care reflects the fact that the trial enrolled a larger proportion of individuals for whom the intervention was more effective. Given the burden of depression among HIV-infected adults, more effective interventions to improve depression are urgently needed. However, examining the transportability of trial findings is essential to understand whether similar effects can be expected if interventions are scaled-up.
Authors: Madhukar H Trivedi; A John Rush; Stephen R Wisniewski; Andrew A Nierenberg; Diane Warden; Louise Ritz; Grayson Norquist; Robert H Howland; Barry Lebowitz; Patrick J McGrath; Kathy Shores-Wilson; Melanie M Biggs; G K Balasubramani; Maurizio Fava Journal: Am J Psychiatry Date: 2006-01 Impact factor: 18.112
Authors: Diane Warden; Madhukar H Trivedi; Thomas Carmody; Marisa Toups; Sidney Zisook; Ira Lesser; Alyson Myers; Kolette Ring Benji Kurian; David Morris; A John Rush Journal: J Psychiatr Pract Date: 2014-03 Impact factor: 1.325
Authors: Joel T Braslow; Naihua Duan; Sarah L Starks; Antonio Polo; Elizabeth Bromley; Kenneth B Wells Journal: Psychiatr Serv Date: 2005-10 Impact factor: 3.084
Authors: J Leserman; E D Jackson; J M Petitto; R N Golden; S G Silva; D O Perkins; J Cai; J D Folds; D L Evans Journal: Psychosom Med Date: 1999 May-Jun Impact factor: 4.312
Authors: Brian W Pence; Bradley N Gaynes; Julie L Adams; Nathan M Thielman; Amy D Heine; Michael J Mugavero; Teena McGuinness; James L Raper; James H Willig; Kristen G Shirey; Michelle Ogle; Elizabeth L Turner; E Byrd Quinlivan Journal: AIDS Date: 2015-09-24 Impact factor: 4.177
Authors: Stephen R Wisniewski; A John Rush; Andrew A Nierenberg; Bradley N Gaynes; Diane Warden; James F Luther; Patrick J McGrath; Philip W Lavori; Michael E Thase; Maurizio Fava; Madhukar H Trivedi Journal: Am J Psychiatry Date: 2009-04-01 Impact factor: 18.112
Authors: Katherine B Rucinski; Sheree R Schwartz; Kimberly A Powers; Brian W Pence; Benjamin H Chi; Vivian Black; Helen Rees; Audrey E Pettifor Journal: AIDS Behav Date: 2020-06
Authors: Cheng Wang; Katie R Mollan; Michael G Hudgens; Joseph D Tucker; Heping Zheng; Weiming Tang; Li Ling Journal: J Epidemiol Community Health Date: 2017-11-28 Impact factor: 3.710
Authors: Itziar Familiar; Alla Sikorskii; Sarah Murray; Horacio Ruisenor-Escudero; Noeline Nakasujja; Clinton Korneffel; Michael Boivin; Judith Bass Journal: AIDS Behav Date: 2019-12
Authors: Violeta J Rodriguez; Omar Sued; Diego Cecchini; Lissa N Mandell; Lina M Bofill; Stephen M Weiss; Isabel Cassetti; Pedro Cahn; Deborah L Jones Journal: AIDS Care Date: 2018-04-01
Authors: Marissa J Seamans; Hwanhee Hong; Benjamin Ackerman; Ian Schmid; Elizabeth A Stuart Journal: Epidemiology Date: 2021-05-01 Impact factor: 4.860