J Acquir Immune Defic Syndr 2021 Aug 30. Epub 2021 Aug 30.
Rhode Island Hospital; Alpert Medical School of Brown University, USA Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA University of Texas Southwestern Medical Center at Dallas, USA FHI 360, Durham, North Carolina, USA University of Colorado School of Medicine, Children's Hospital Colorado, CO, USA Frontier Science Foundation, Amherst, New York, USA National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, Maryland, USA BronxCare Health System, Division of Pediatric Infectious Disease, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA Jacobi Medical Center, Bronx, NY, USA University of California, San Diego, La Jolla, CA and Rady Children's Hospital San Diego, CA, USA Johns Hopkins University, Baltimore, MD USA.
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, ages 12-24 years at thirteen United States sites of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT).
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 (ESC), 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: 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 to ESC 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 to standard care at HIV clinics.