Impact of integrated and measurement-based depression care: clinical experience in an HIV clinic.
BACKGROUND
Just as in heart disease and diabetes, depression in HIV/AIDS is associated with negative outcomes. While randomized trials have shown the efficacy of treatment for depression in HIV/AIDS, the implementation of evidence-based treatments in real-world settings remains a challenge.


OBJECTIVE
The objective of this study was to assess the effectiveness of a collaborative, measurement-based approach to depression care, including psychopharmacologic and ancillary psychological therapies in patients with HIV/AIDS and to examine whether or not effective depression treatment would also improve virologic and immunologic outcomes.


METHODS
This was a retrospective chart review of patients referred for depression to a co-located psychiatry consultation service embedded within an infectious diseases outpatient clinic at an urban tertiary hospital. Data extracted at initial assessment and at last appointment included: axis I diagnosis, whether the patient was on an antidepressant, whether the patient was on a stimulant, BDI-II score, HIV RNA level, and CD4 cell count.


RESULTS
One hundred twenty-four patient charts were included. Pre- vs. post-treatment analyses revealed significant reductions in depression (average BDI-II score of 23 to 15.7, p = 0.00001) and HIV RNA (14.1 K to 4 K copies/mL, p = 0 .003), and significant increases in CD4 count (518 to 592 cells/μL, p = 0.001). Additionally, more participants were prescribed antidepressants and stimulants at post- vs. pre-treatment.


CONCLUSIONS
Taking a collaborative, measurement-based approach to depression care appears to be an effective method for improving depression, virologic, and immunologic outcomes in depressed patients with HIV/AIDS illness.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA. smc9@u.washington.edu
Shane M
SM
Coleman
Aaron J
AJ
Blashill
Rajesh T
RT
Gandhi
Steven A
SA
Safren
Oliver
O
Freudenreich
D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001900:Boston; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D003299:Cooperative Behavior; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000628:therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D019562:Viral Load
D000928:Antidepressive Agents