title: Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial.
abstract: OBJECTIVE
  Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment adherence. Injection drug users comprise a substantial portion of individuals with HIV in the United States and globally. The present study tested cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with HIV and depression in active substance abuse treatment for injection drug use.
  
  
  METHODS
  This is a 2-arm, randomized controlled trial (N = 89) comparing CBT-AD with enhanced treatment as usual (ETAU). Analyses were conducted for two time-frames: (a) baseline to post-treatment and (b) post-treatment to follow-up at 3 and 6 months after intervention discontinuation.
  
  
  RESULTS
  At post-treatment, the CBT-AD condition showed significantly greater improvement than ETAU in MEMS (electronic pill cap) based adherence, γslope = 0.8873, t(86) = 2.38, p = .02; dGMA-raw = 0.64, and depression, assessed by blinded assessor: Mongomery-Asberg Depression Rating Scale, F(1, 79) = 6.52, p < .01, d = 0.55; clinical global impression, F(1, 79) = 14.77, p < .001, d = 0.85. After treatment discontinuation, depression gains were maintained, but adherence gains were not. Viral load did not differ across condition; however, the CBT-AD condition had significant improvements in CD4 cell counts over time compared with ETAU, γslope = 2.09, t(76) = 2.20, p = .03, dGMA-raw = 0.60.
  
  
  CONCLUSIONS
  In patients managing multiple challenges including HIV, depression, substance dependence, and adherence, CBT-AD is a useful way to integrate treatment of depression with an adherence intervention. Continued adherence counseling is likely needed, however, to maintain or augment adherence gains in this population.
authors.affiliation: Massachusetts General Hospital. ssafren@partners.org
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Conall M
authors.initials: CM
authors.lastname: O'Cleirigh
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Bullis
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
mesh_terms: D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology* / Q000628:therapy; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy; D016896:Treatment Outcome