title: Effectiveness of collaborative care for depression in human immunodeficiency virus clinics.
abstract: BACKGROUND
  Depression is common among persons with the human immunodeficiency virus (HIV) and is associated with unfavorable outcomes.
  
  
  METHODS
  A single-blind randomized controlled effectiveness trial at 3 Veterans Affairs HIV clinics (HIV Translating Initiatives for Depression Into Effective Solutions [HITIDES]). The HITIDES intervention consisted of an off-site HIV depression care team (a registered nurse depression care manager, pharmacist, and psychiatrist) that delivered up to 12 months of collaborative care backed by a Web-based decision support system. Participants who completed the baseline telephone interview were 249 HIV-infected patients with depression, of whom 123 were randomized to the intervention and 126 to usual care. Participant interview data were collected at baseline and at the 6- and 12-month follow-up visits. The primary outcome was depression severity measured using the 20-item Hopkins Symptom Checklist (SCL-20) and reported as treatment response (≥50% decrease in SCL-20 item score), remission (mean SCL-20 item score, <0.5), and depression-free days. Secondary outcomes were health-related quality of life, health status, HIV symptom severity, and antidepressant or HIV medication regimen adherence.
  
  
  RESULTS
  Intervention participants were more likely to report treatment response (33.3% vs 17.5%) (odds ratio, 2.50; 95% confidence interval [CI], 1.37-4.56) and remission (22.0% vs 11.9%) (2.25; 1.11-4.54) at 6 months but not 12 months. Intervention participants reported more depression-free days during the 12 months (β = 19.3; 95% CI, 10.9-27.6; P < .001). Significant intervention effects were observed for lowering HIV symptom severity at 6 months (β = -2.6; 95% CI, -3.5 to -1.8; P < .001) and 12 months (β = -0.82; -1.6 to -0.07; P = .03). Intervention effects were not significant for other secondary outcomes.
  
  
  CONCLUSIONS
  The HITIDES intervention improved depression and HIV symptom outcomes and may serve as a model for collaborative care interventions in HIV and other specialty physical health care settings where patients find their "medical home."
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00304915.
authors.affiliation: Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, and Educational Center and Psychiatric Research Institute, University of Arkansas for Medical Sciences, North Little Rock, Arkansas 72114, USA. jmpyne@uams.edu
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Curran
authors.forename: Shanti
authors.initials: S
authors.lastname: Tripathi
authors.forename: J H
authors.initials: JH
authors.lastname: Atkinson
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Hildi J
authors.initials: HJ
authors.lastname: Hagedorn
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Thomas
authors.initials: T
authors.lastname: Monson
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Bottonari
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy / Q000209:etiology* / Q000451:nursing; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000451:nursing / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009718:Nurse Administrators; D016017:Odds Ratio; D010348:Patient Care Team; D010595:Pharmacists; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D011570:Psychiatry; D011788:Quality of Life; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000928:Antidepressive Agents