Collaborative Care Intervention Improves Depression in Veterans with HIV
Depression is one of the most common mental health disorders that afflict individuals infected with HIV, yet evidence suggests that depression is under-diagnosed and under-treated in routine HIV care. Moreover, depression in patients with HIV may be associated with accelerated HIV disease progression, decreased immune functioning, HIV medication non-adherence, and increased risk of mortality. The goal of this study was to adapt an evidence-based primary care model of depression collaborative care for HIV clinic settings – and to evaluate its effectiveness. HIV Translating Initiatives for Depression into Effective Solutions (HITIDES), a single-blind, randomized controlled effectiveness trial, was implemented at three VA HIV clinics and compared to usual care. Investigators reviewed patient interview data collected at baseline, 6, and 12 months for 249 Veterans with HIV and depression (123 intervention; 126 usual care). The primary outcome was depression severity; secondary outcomes included health-related quality of life, health status, HIV symptom severity, and medication adherence.
Findings show that the HITIDES intervention was successfully implemented in HIV settings and improved both depression and HIV symptom outcomes. Veterans who participated in the intervention were more likely to report treatment response (33% vs. 18%) and remission (22% vs. 12%) compared to Veterans in usual care at 6-month follow-up but not at 12-month follow-up. Improved depression response and remission outcomes at 6 but not 12 months suggest that depression symptoms improved more rapidly in the intervention group compared to usual care. Intervention participants also reported more depression-free days over 12 months. Compared to usual care, significant intervention effects also were observed for lowered HIV symptom severity at 6 and 12 months, but not for the other secondary outcomes. The authors suggest that the HITIDES intervention may serve as a model for collaborative care interventions in other specialty physical healthcare settings.
Pyne J, Fortney J, Curran G, et al. Effectiveness of collaborative care for depression in HIV clinics. Archives of Internal Medicine January 10, 2011;171(1):23-31.
This study was funded by HSR&D (MNT 05-152). Drs. Pyne, Fortney, and Curran are part of HSR&D’s Center for Mental Healthcare and Outcomes Research in North Little Rock, AR.