Researchers develop model for treating HIV/AIDS, depression

Date:
December 1, 2021
Source:
University of Miami
Summary:
With a shortage of mental health professionals, an international
team trained nurses to treat clinically depressed HIV-positive
people in South Africa -- the HIV/AIDS capital of the world.



FULL STORY ========================================================================== Today, people living with HIV/AIDS can remain healthy if they are able
to engage in routine care and take the medicines that reduce their virus
to undetectable levels. But for people with HIV who are also struggling
with depression, that's often an insurmountable challenge, especially
in South Africa, home to the highest number of cases in the world and
a significant shortage of mental health professionals.


==========================================================================
But a new study in the Journal of the International AIDS Society has
local and global implications for successfully treating both mental
health and HIV/AIDS in settings like South Africa -- or even Miami,
the epicenter of new cases in the United States.

In the study, an international team of researchers -- led by the
University of Miami's Steven Safren and two colleagues -- demonstrated
the effectiveness of training nurses in public HIV clinics to deliver a specially adapted cognitive behavior therapy (CBT) to help people with depression and uncontrolled HIV adhere to their prescribed medication
regiment. CBT is a proven approach for changing faulty or unhelpful
thinking or behavioral patterns.

"We know that treating HIV-positive people who are clinically depressed
with antidepressants alone does not affect their viral loads. Their
depression may improve, but their adherence does not," said Safren,
professor of psychology and director of the University's Center for
HIV/AIDS Research and Mental Health. "So, given the global shortage of
mental health professionals, we showed it is possible to train nurses
to deliver cognitive-behavioral therapy for adherence and depression
(CBT-AD), an intervention that successfully addresses both clinical
depression and uncontrolled HIV." Safren, who joined the University in
2015 from Harvard Medical School, conducted the study in a poor township
just outside of Cape Town, South Africa, with fellow researchers John
A. Joska, director of the HIV Mental Health Research Unit and professor
of psychiatry at the University of Cape Town, and Conall O'Cleirigh,
associate professor of psychology at Harvard and director of Behavioral Medicine at Massachusetts General Hospital.

For their study, the researchers recruited 161 patients with uncontrolled
HIV/ AIDS and clinical depression from four public health clinics in
the township of Khayelitsha. Although a medical officer could prescribe antidepressants to the patients, the clinics have limited psychological services -- as does the country in general. According to the study,
South Africa only has 0.28 psychiatrists and 0.32 psychologists per
100,000 people.



==========================================================================
At the onset of the study, all participants received the usual enhanced
care for clinically depressed HIV-AIDS patients who did not achieve
viral suppression after receiving the first month of their antiretroviral medication.

That customary treatment included another prescription and follow-up
meetings with an adherence counselor.

But half the patients were also randomly assigned to attend eight CBT-AD sessions, where specially trained nurses integrated strategies for
treating depression with adherence counseling that included modules on
life skills, depression, relaxation, mood monitoring, and problem-solving.

The idea, Safren said, was to help patients "turn down the volume" of
their mental health symptoms, so they would be more open to counseling
on the benefit of taking their medication. To track their adherence,
the patients also received an electronic pill box that, every time it
was opened, transmitted a real-time signal to a web server.

And, researchers found, the task-shared approach delivered by nurses
proved effective. Patients who completed the CBT-AD sessions were more
than 2.5 times more likely to achieve undetectable viral loads that
those who underwent the usual care.

Now, Safren noted, the next step will be for the research team to evaluate
how to sustainably implement the CBT-AD approach in South Africa, or even
South Florida. He said the task-shared approach could be viable in Miami,
where there are fewer services to help people achieve viral suppression
than in other U.S.

cities with large populations of people living with the virus.

"South Africa has the most cases of HIV/AIDS in the world and Miami is
the city with the highest incidence of new cases in the U.S. -- so there
is a parallel," Safren pointed out. "And unlike places like New York or Massachusetts, where people are more likely to be virally suppressed,
Florida doesn't have the same public health resources. If, for example,
you're an HIV patient at Massachusetts General or Fenway Health, where
I used to work, and you miss your visit, or your viral load becomes uncontrolled, social workers will swoop in and provide assistance. That
doesn't happen as often in Florida and other places in the U.S. with
less public health HIV/AIDS funding." In addition to Safren, Joska,
and O'Cleirigh, other co-authors on the study included Jasper S. Lee, a
Ph.D. student, and Sierra A. Bainter, an assistant professor, both in the Department of Psychology at the University; as well as researchers from
the University of Maryland, College Park; the University of Science and Technology in Mbarara, Uganda; the University of Washington in Seattle;
and Stellenbosch University in Stellenbosch, South Africa.

========================================================================== Story Source: Materials provided by University_of_Miami. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Steven A. Safren, Conall O'Cleirigh, Lena S. Andersen, Jessica F.

Magidson, Jasper S. Lee, Sierra A. Bainter, Nicholas Musinguzi,
Jane Simoni, Ashraf Kagee, John A. Joska. Treating depression and
improving adherence in HIV care with task‐shared cognitive
behavioural therapy in Khayelitsha, South Africa: a randomized
controlled trial.

Journal of the International AIDS Society, 2021; 24 (10) DOI:
10.1002/ jia2.25823 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211201162038.htm

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