Treatment for depression and adherence in people living with HIV in Zimbabwe

津巴布韦艾滋病毒感染者的抑郁症治疗和依从性

• 批准号: 8651540
• 负责人: MELANIE AMNA ABAS
• 金额: $ 10.04万
• 依托单位: KING'S COLLEGE LONDON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-11 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8651540
• 关键词: Adherence; Adult; Africa; Africa South of the Sahara; Anti-Retroviral Agents; Antidepressive Agents; Area; Award; Behavioral; CD4 Lymphocyte Count; Caring; Clinical Trials Design; Cognitive; Collaborations; Commit; Country; Data; Disease Outcome; Disease Progression; Drops; Educational process of instructing; Faculty; Funding; Future; Goals; HIV; Health Psychology; Health Sciences; Healthcare; Income; Institutes; Intervention; Intervention Trial; Learning; Life; Longitudinal Studies; Medical Education; Mental Depression; Mental Health; Mentors; Methods; Modeling; Monitor; Needs Assessment; Neurocognitive; Phase; Pilot Projects; Population; Problem Solving; Psychiatry; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Methodology; Research Personnel; Sampling; Severities; South Africa; Structure; Testing; United States National Institutes of Health; Universities; Work; Zimbabwe; antiretroviral therapy; arm; base; behavior change; burden of illness; college; cost; depressive symptoms; effective therapy; improved; intervention effect; medical schools; mortality; pill; psychosocial; public health relevance; response; standard care; systematic review; treatment as usual

DESCRIPTION (provided by applicant): Treatment to improve depression and adherence to antiretroviral therapy in people living with HIV in Zimbabwe (TENDAI) Among the Zimbabwe adult population, 350,000 are currently eligible for ART, a figure rising to 500,000 by 2015 (UNAIDS 2010). Depression causes considerable added disease burden among people living with HIV. However there have been no trials of depression treatment among people living with HIV in Africa. Longitudinal studies show an association between depression at baseline and HIV disease outcomes including HIV disease progression, poor adherence to antiretroviral therapy, and mortality. Lack of evidence on culturally appropriate and effective treatment models is a barrier in treating depression in PLWH in Africa. The first aim of this proposal is to finalize an integrated intervention to treat depression and improve adherence to antiretroviral therapy in an antiretroviral therapy prescribing facility in Zimbabwe. To do this we will carry out qualitative testing to develop more understanding of our intervention, of the best method of delivering it, and of its possible effects. The second aim is conduct a pilot randomized controlled trial of this intervention compared to enhanced usual care, to test the feasibility for a future trial and to estimate the effect of the integrated depression-adherence intervention on antiretroviral adherence, CD4 lymphocyte count, and depression. The main aims of the exploratory trial are 1) to test the feasibility of recruiting and randomising PLWH with co-morbid depression into an RCT of the depression- adherence intervention 2) to monitor the delivery of the intervention using audio recording of 10% of sessions for each practitioner 3) to test ways of following up and minimizing drop out at 3 and 6 months 4) to determine a comparison arm for a future main trial and 5) to gather data to allow estimates to be made of the effect of the intervention to inform the sample required for a main trial. We will carry out the research through our dynamic collaborative partnership between researchers in Zimbabwe and outside faculty from the UK, US, and South Africa. Partnerships within the group are already strong, including collaboration over the PEPFAR/NIH-funded Medical Education Partnership Initiative (MEPI) award to the University of Zimbabwe College of Health Sciences. Capacity building will take place throughout the proposed study providing short courses in Zimbabwe taught by experts in the fields of research methods in mental health, in neurocognitive aspects of HIV and in integrated interventions at the intersection of psychology and health, and through 'learning by doing' with face-to-face and distance mentoring by partners from the Institute of Psychiatry and Bristol University UK, from Harvard Medical School and from the University of Cape Town. The partnership will work together to further define the research area and implement pilot studies.

描述（由申请人提供）：在津巴布韦成年人口中，在津巴布韦（Tendai）的艾滋病毒患者中改善抑郁和遵守抗逆转录病毒疗法的治疗，目前有350,000名有资格获得ART，到2015年到2015年，这一数字上升到500,000（UNAIDS 2010）。抑郁症会导致艾滋病毒患者的大量增加疾病负担。然而，非洲艾滋病毒患者之间没有对抑郁症治疗的试验。纵向研究表明，基线上的抑郁症与HIV疾病结局之间的关联，包括HIV疾病进展，对抗逆转录病毒疗法的依从性差和死亡率。缺乏关于文化适当和有效治疗模型的证据是治疗非洲PLWH抑郁症的障碍。该提案的第一个目的是确定综合干预措施，以治疗抑郁症并提高津巴布韦抗逆转录病毒疗法处方设施中的抗逆转录病毒疗法。为此，我们将进行定性测试，以更多地了解我们的干预，最佳交付方法及其可能的影响。第二个目的是与增强的常规护理相比，进行该干预措施的试验随机对照试验，以测试未来试验的可行性，并估算综合抑郁症干预对抗逆转录病毒依从性，CD4淋巴细胞计数和抑郁症的影响。探索性试验的主要目的是1）测试与抑郁症的可行性和随机抑郁症的可行性，使其抑郁症进入抑郁症的RCT，以监视使用每次实践者的音频记录10％的音频记录的干预措施的交付2），每次实践者3）以允许在3和3个月进行测试，以确定3个月的次数，以确定3个月的速度，以确定一个未来的速度，以确定一个未来的速度。是由干预措施的效果制成的，以告知主要试验所需的样本。我们将通过我们在津巴布韦的研究人员与英国，美国和南非教职员工之间的动态合作伙伴关系进行研究。该小组内部的合作伙伴关系已经很强，包括在津巴布韦大学健康科学学院授予PEPFAR/NIH资助的医学教育伙伴关系倡议（MEPI）奖。能力建设将在整个拟议的研究中进行，从而提供津巴布韦的短期课程，由专家在心理健康研究方法，艾滋病毒的神经认知方面以及心理学与健康交叉路口的整合干预措施中，以及通过“与大学和布里斯特大学的伙伴的面对面的指导”进行培训，并通过“通过面对面和远距离进行培训来学习”，并从事教学和布里斯特大学的指导，从事综合和远距离的学习。该伙伴关系将共同努力，进一步定义研究领域并实施试点研究。

项目成果

Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa.

• DOI: 10.1007/s10461-016-1659-4
• 发表时间: 2018-01
• 期刊: AIDS and behavior
• 影响因子: 4.4
• 作者: Abas M;Nyamayaro P;Bere T;Saruchera E;Mothobi N;Simms V;Mangezi W;Macpherson K;Croome N;Magidson J;Makadzange A;Safren S;Chibanda D;O'Cleirigh C
• 通讯作者: O'Cleirigh C