Measurement-based care for depression in resource-poor settings

资源匮乏地区基于测量的抑郁症护理

• 批准号: 8659819
• 负责人: JESSY G DEVIEUX
• 金额: $ 17.18万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-03 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8659819
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Adult; Adverse effects; Affect; Africa; Africa South of the Sahara; Algorithms; Anti-Retroviral Agents; Antidepressive Agents; Attention; Behavior; Caribbean region; Caring; Clinic; Clinical; Clinical Treatment; Clinical Trials Unit; Cognitive; Communities; Comorbidity; Country; Data; Depressed mood; Development; Diagnosis; Disease remission; Environment; Epidemic; Evaluation; Exploratory/Developmental Grant; Failure; Future; HIV; HIV Infections; HIV Seropositivity; Haiti; Health; Health Personnel; Health system; Human Resources; Income; Individual; Infection; Intervention; Left; Life; Major Depressive Disorder; Measurement; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Monitor; Nurses; Patients; Pharmaceutical Preparations; Physicians; Population; Primary Health Care; Procedures; Protocols documentation; Psychosocial Assessment and Care; Psychosocial Factor; Randomized; Randomized Clinical Trials; Reporting; Research Infrastructure; Resources; Risk Behaviors; Services; Source; System; Testing; Training; Treatment Cost; Treatment outcome; United States; United States National Institutes of Health; Work; adverse outcome; antiretroviral therapy; base; clinical care; cognitive function; cost; depressive symptoms; evidence base; experience; immune function; improved; innovation; instrument; mortality; neglect; programs; psychosocial; public health relevance; response; satisfaction; scale up; screening; staff intervention; therapy development; treatment adherence; treatment as usual; treatment center; treatment response

DESCRIPTION (provided by applicant): Mental health comorbidities are common in HIV-infected populations, and depression is frequently the most prevalent and highly neglected despite evidence of is adverse effects on adherence to antiretroviral treatment (ART), cognitive and immunological function, and risky behavior. The measurement, monitoring and support to reduce adverse outcomes and needless suffering from depression is woefully inadequate in most HIV clinical care worldwide, and frequently negligible in low-and-middle income countries (LMICs). In Haiti, it is largely nonexistent. After Sub-Saharan Africa, the most HIV-affected region in the world is the Caribbean; 50% of people with HIV infection live in Haiti, one of the most challenging and deprived environments among LMICs. Managed approaches to depression, including algorithm-guided antidepressant treatment, have shown efficacy in general primary care populations and recent promise in the care of HIV patients in the United States. However, they have not been studied for use with auxiliary personnel in LMICs. Without integrated psychosocial care and support, gains against the epidemic from ART scale up in these countries will not be sustainable. LMICs like Haiti offer an opportunity to build on the ART clinical network to create similar measurement, monitoring and support models in mental health, which can be used as a source of innovation in the general health system. We propose a study to develop and evaluate an auxiliary-driven model of depression management among HIV positive individuals initiating ART at the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) centers in Port-au-Prince, which is responsible for 50% of the ART population in Haiti. Our proposed approach is based on an evidence-based model of measurement-based care (MBC), which guides HIV clinical staff and physicians in algorithm- based antidepressant treatment. We will conduct a pilot and evaluate feasibility and costs in a small randomized clinical trial (RCT). This proposed R21 developmental and exploratory study will produce the first systematic formative work of psychosocial factors related to depression in Haiti, and will be the first to apply and test the MBC approach with auxiliary personnel in an LMIC's ART system.

描述（由申请人提供）：心理健康合并症在艾滋病毒感染的人群中很常见，尽管证据表明对遵守抗逆转录病毒治疗（ART），认知和免疫功能和风险行为，但抑郁症通常是最普遍和高度忽视的。在全球大多数HIV临床护理中，测量，监测和支持以减少抑郁症的不良后果和不必要的痛苦是严重的，并且在低和中间收入国家（LMIC）中通常可以忽略不计。在海地，这主要不存在。在撒哈拉以南非洲之后，世界上受艾滋病毒影响最大的地区是加勒比海地区。 50％的艾滋病毒感染患者生活在海地，这是LMIC中最具挑战性和最贫困的环境之一。包括算法引导的抗抑郁药治疗在内的托管抑郁症方法在普通医疗群体中表现出疗效，并且最近在美国的HIV患者护理中有希望。但是，尚未将它们与LMIC中的辅助人员一起使用。如果没有综合的社会心理护理和支持，在这些国家 /地区对艺术规模的流行病的收益将是不可持续的。像海地这样的LMIC提供了一个建立在艺术临床网络上的机会，以创建类似的心理健康测量，监测和支持模型，这可以用作通用卫生系统中的创新来源。我们提出了一项研究，以开发和评估艾滋病毒阳性人物的辅助驱动的抑郁管理模型，该模型是在海蒂 - au-port-au-port-au-port-au-portine的海地海地d'Etude du sarcome du sarcome d de Kaposi de Kaposi de Kaposi de Kaposi de Kaposi de Kaposi et des Invections的中心的中心，该中心负责海地的50％的艺术人群。我们提出的方法基于基于循证的基于测量的护理模型（MBC），该模型可指导HIV临床人员和医生基于算法的抗抑郁药治疗。我们将在一项小型随机临床试验（RCT）中进行试点并评估可行性和成本。这项拟议的R21发展和探索性研究将产生与海地抑郁症有关的心理社会因素的首次系统形成性工作，并将是第一个使用LMIC艺术系统中辅助人员应用和测试MBC方法的人。