Larry K Brown1, Miriam Chernoff2, Betsy D Kennard3, Graham J Emslie3, Kathryn Lypen4, Sarah Buisson4, Adriana Weinberg5, Laura B Whiteley1, Shirley Traite2, Chelsea Krotje6, Lauren Harriff6, Ellen Townley7, Amber Bunch5, Murli Purswani8, Ray Shaw9, Stephen A Spector10,11, Allison Agwu12, David E Shapiro2. 1. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI. 2. Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA. 3. Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. 4. FHI 360, Durham, NC. 5. Pediatrics-Infectious Diseases, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO. 6. Frontier Science Foundation, Amherst, NY. 7. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD. 8. BronxCare Health System, Division of Pediatric Infectious Disease, Icahn School of Medicine at Mount Sinai, Bronx, NY. 9. Jacobi Medical Center, Bronx, NY. 10. Division of Pediatric Infectious Diseases, University of California, San Diego, La Jolla, CA. 11. Infectious Diseases, Rady Children's Hospital San Diego, San Diego, CA; and. 12. Pediatric Infectious Diseases, Johns Hopkins University, Baltimore, MD.
Abstract
BACKGROUND: Depression is frequent among youth living with HIV (YLWH). Studies suggest that manualized treatment guided by symptom measurement is more efficacious than usual care. SETTING: This study evaluated manualized, measurement-guided depression treatment among YLWH, aged 12-24 years at 13 US sites of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network. METHODS: Using restricted randomization, sites were assigned to either a 24-week, combination cognitive behavioral therapy and medication management algorithm (COMB-R) tailored for YLWH or to enhanced standard of care, which provided standard psychotherapy and medication management. Eligibility included diagnosis of nonpsychotic depression and current depressive symptoms. Arm comparisons used t tests on site-level means. RESULTS: Thirteen sites enrolled 156 YLWH, with a median of 13 participants per site (range 2-16). At baseline, there were no significant differences between arms on demographic factors, severity of depression, or HIV status. The average site-level participant characteristics were as follows: mean age of 21 years, 45% male, 61% Black, and 53% acquired HIV through perinatal transmission. At week 24, youth at COMB-R sites, compared with enhanced standard of care sites, reported significantly fewer depressive symptoms on the Quick Inventory for Depression Symptomatology Self-Report (QIDS-SR score 6.7 vs. 10.6, P = 0.01) and a greater proportion in remission (QIDS-SR score ≤ 5; 47.9% vs. 17.0%, P = 0.01). The site mean HIV viral load and CD4 T-cell level were not significantly different between arms at week 24. CONCLUSIONS: A manualized, measurement-guided psychotherapy and medication management algorithm tailored for YLWH significantly reduced depressive symptoms compared with standard care at HIV clinics.
BACKGROUND: Depression is frequent among youth living with HIV (YLWH). Studies suggest that manualized treatment guided by symptom measurement is more efficacious than usual care. SETTING: This study evaluated manualized, measurement-guided depression treatment among YLWH, aged 12-24 years at 13 US sites of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network. METHODS: Using restricted randomization, sites were assigned to either a 24-week, combination cognitive behavioral therapy and medication management algorithm (COMB-R) tailored for YLWH or to enhanced standard of care, which provided standard psychotherapy and medication management. Eligibility included diagnosis of nonpsychotic depression and current depressive symptoms. Arm comparisons used t tests on site-level means. RESULTS: Thirteen sites enrolled 156 YLWH, with a median of 13 participants per site (range 2-16). At baseline, there were no significant differences between arms on demographic factors, severity of depression, or HIV status. The average site-level participant characteristics were as follows: mean age of 21 years, 45% male, 61% Black, and 53% acquired HIV through perinatal transmission. At week 24, youth at COMB-R sites, compared with enhanced standard of care sites, reported significantly fewer depressive symptoms on the Quick Inventory for Depression Symptomatology Self-Report (QIDS-SR score 6.7 vs. 10.6, P = 0.01) and a greater proportion in remission (QIDS-SR score ≤ 5; 47.9% vs. 17.0%, P = 0.01). The site mean HIV viral load and CD4 T-cell level were not significantly different between arms at week 24. CONCLUSIONS: A manualized, measurement-guided psychotherapy and medication management algorithm tailored for YLWH significantly reduced depressive symptoms compared with standard care at HIV clinics.
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