Effectiveness of Collaborative Care for Depression in Human Immunodeficiency Virus Clinics
Background: Depression is common among persons with the human immunodeficiency virus (HIV) and is associated with unfavorable outcomes.
Methods: A single-blind randomized controlled effectiveness trial at 3 Veterans Affairs HIV clinics (HIV Translating Initiatives for Depression Into Effective Solutions [HITIDES]). The HITIDES intervention consisted of an offsite HIV depression care team (a registered nurse depression care manager, pharmacist, and psychiatrist) that delivered up to 12 months of collaborative care backed by a Web-based decision support system. Participants who completed the baseline telephone interview were 249 HIV infected patients with depression, of whom 123 were randomized to the intervention and 126 to usual care. Participant interview data were collected at baseline and at the 6- and 12-month follow-up visits. The primary outcome was depression severity measured using the 20- item Hopkins Symptom Checklist (SCL-20) and reported as treatment response (50% decrease in SCL-20 item score), remission (mean SCL-20 item score,0.5), and depression-free days. Secondary outcomes were health-related quality of life, health status, HIV symptom severity, and antidepressant or HIV medication regimen adherence.
Results: Intervention participants were more likely to report treatment response (33.3% vs 17.5%) (odds ratio, 2.50; 95% confidence interval [CI], 1.37-4.56) and remission (22.0% vs 11.9%) (2.25; 1.11-4.54) at 6 months but not 12 months. Intervention participants reported more depression-free days during the 12 months (=19.3; 95% CI, 10.9-27.6; P.001). Significant intervention effects were observed for lowering HIV symptom severity at 6 months (=−2.6; 95% CI, −3.5 to −1.8; P.001) and 12 months (=−0.82; −1.6 to −0.07; P=.03). Intervention effects were not significant for other secondary outcomes.
Conclusion: The HITIDES intervention improved depression and HIV symptom outcomes and may serve as a model for collaborative care interventions in HIV and other specialty physical health care settings where patients find their “medical home.”
Trial Registration: clinicaltrials.gov Identifier: NCT00304915
Jeffrey M. Pyne, MD; John C. Fortney, PhD; Geoffrey M. Curran, PhD; Shanti Tripathi, MS; J. H. Atkinson, MD; Amy M. Kilbourne, PhD; Hildi J. Hagedorn, PhD; David Rimland, MD; Maria C. Rodriguez-Barradas, MD; Thomas Monson, MD; Kathryn A. Bottonari, PhD; Steven M. Asch, MD; Allen L. Gifford, MD