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Collaborative care intervention improved depression, symptom outcomes in patients with HIV

Pyne J. Arch Intern Med. 2011;171:23-31.

Issue: February 2011

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A collaborative care model for depression led to improvements in depression and symptom outcomes in patients with HIV. Researchers therefore recommend implementing the intervention in specialty HIV settings, according to findings from the HIV Translating Initiatives for Depression Into Effective Solutions trial.

“The goal of this study was to adapt an evidence-based primary care model for collaborative care of depression to clinical settings and evaluate the model’s clinical effectiveness,” Jeffrey M. Pyne, MD, of the Center for Mental Healthcare and Outcomes Research of Central Arkansas Veterans Healthcare System, told Infectious Disease News.

For the single-blind, randomized, controlled-effectiveness trial, Pyne and colleagues randomly assigned 123 patients to an intervention group compared with 126 patients assigned to a usual care group. Data were pooled at baseline, 6 months and 1 year. Depression severity was measured with the Hopkins Symptom Checklist.

Primary outcome measure was depression severity. Secondary outcome measures were health-associated quality-of-life, health status, HIV-symptom severity and adherence to medication.

At 6 months, patients assigned to the intervention group were more likely than those assigned usual care to report treatment response (33.3% vs. 17.5%; OR=2.5; 95% CI, 1.37-4.56) and remission (22% vs. 11.9%; OR=2.25; 95% CI, 1.11-4.54). At 1 year, more depression-free days were reported among those assigned the intervention compared with those assigned usual care (95% CI, 10.9-27.6).

Further, the intervention was associated with a decrease in HIV-symptom severity at 6 months (95% CI, –3.5 to –1.8) and at 1 year (95% CI, –1.6 to –0.07).

“The collaborative care for depression intervention was effective in terms of depression and HIV outcomes. Specialty HIV settings should consider implementing this intervention,” Pyne said. – by Ashley DeNyse

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