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）：精神健康合并症在 HIV 感染人群中很常见，其中抑郁症往往是最普遍且高度被忽视的，尽管有证据表明抑郁症对抗逆转录病毒治疗 (ART) 的依从性、认知和免疫功能产生不利影响，并且存在风险行为。在全球大多数艾滋病毒临床护理中，为减少不良后果和不必要的抑郁症而进行的测量、监测和支持严重不足，而且在中低收入国家 (LMIC) 往往可以忽略不计。在海地，这种情况基本上不存在。继撒哈拉以南非洲之后，世界上受艾滋病毒影响最严重的地区是加勒比地区； 50% 的艾滋病毒感染者生活在海地，这是中低收入国家中最具挑战性和最贫困的环境之一。抑郁症的管理方法，包括算法引导的抗抑郁治疗，已在一般初级保健人群中显示出疗效，并且最近在美国艾滋病毒患者的护理中取得了希望。然而，尚未对它们与中低收入国家辅助人员的使用进行研究。如果没有综合的社会心理护理和支持，这些国家通过扩大抗逆转录病毒治疗所取得的抗疫成果将无法持续。像海地这样的中低收入国家提供了一个机会，可以在 ART 临床网络的基础上创建类似的心理健康测量、监测和支持模型，这些模型可以用作总体卫生系统的创新来源。我们提出了一项研究，旨在开发和评估在太子港的 Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) 中心开始 ART 的 HIV 阳性个体的抑郁症管理辅助模型，该模型是占海地 50% 的 ART 人口。我们提出的方法基于基于测量的护理 (MBC) 的循证模型，该模型指导 HIV 临床工作人员和医生进行基于算法的抗抑郁治疗。我们将进行试点并在小型随机临床试验（RCT）中评估可行性和成本。这项拟议的 R21 发展性和探索性研究将在海地首次系统性地研究与抑郁症相关的心理社会因素，并将首次在中低收入国家的 ART 系统中与辅助人员一起应用和测试 MBC 方法。