A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.
OBJECTIVE
To evaluate cognitive-behavioral therapy to enhance medication adherence and reduce depression (CBT-AD) in individuals with HIV.


METHODS
A two arm, randomized, controlled, cross-over trial comparing CBT-AD to enhanced treatment as usual only (ETAU). ETAU, which both groups received, included a single-session intervention for adherence and a letter to the patient's provider documenting her or his continued depression. The intervention group also received 10 to 12 sessions of CBT-AD.


METHODS
Adherence to antiretroviral therapy as assessed by Medication Event Monitoring Systems (MEMs) and depression as assessed by blinded structured evaluation.


RESULTS
At the acute outcome assessment (3-months), those who received CBT-AD evidenced significantly greater improvements in medication adherence and depression relative to the comparison group. Those who were originally assigned to the comparison group who chose to cross over to CBT-AD showed similar improvements in both depression and adherence outcomes. Treatment gains for those in the intervention group were generally maintained at 6- and 12-month follow-up assessments. By the end of the follow-up period, those originally assigned CBT-AD demonstrated improvements in plasma HIV RNA concentrations, though these differences did not emerge before the cross-over, and hence there were not between-groups differences.


CONCLUSIONS
CBT-AD is a potentially efficacious approach for individuals with HIV struggling with depression and adherence. Replication and extension in larger efficacy trials are needed.
Safren
Steven A
SA
Fenway Community Health, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. ssafren@partners.org
O'Cleirigh
Conall
C
Tan
Judy Y
JY
Raminani
Sudha R
SR
Reilly
Laura C
LC
Otto
Michael W
MW
Mayer
Kenneth H
KH
D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D018592:Cross-Over Studies; D003863:Depression / Q000188:drug therapy / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008297:Male; D009511:New England; D010349:Patient Compliance
D044966:Anti-Retroviral Agents