When "need plus supply" does not equal demand: challenges in uptake of depression treatment in HIV clinical care.
OBJECTIVE
Depression is common among patients in HIV care and is associated with worse HIV-related health behaviors and outcomes. Effective depression treatment is available, yet depression remains widely underdiagnosed and undertreated in HIV care.


METHODS
As part of a multisite, randomized trial of depression treatment in HIV clinical care, the proportion of positive depression screens that resulted in study enrollment and reasons for nonenrollment were examined.


RESULTS
Over 33 months, patients completed 9,765 depression screens; 19% were positive for depression, and of these 88% were assessed for study eligibility. Of assessed positive screens, 11% resulted in study enrollment. Nonenrollment after a positive screen was sometimes dictated by the study eligibility criteria, but it was often related to potentially modifiable provider- or patient-level barriers.


CONCLUSIONS
Addressing patient- and provider-level barriers to engaging in depression treatment will be critical to maximize the reach of depression treatment services for HIV patients.
Dr. Pence is with the Department of Epidemiology, University of North Carolina, Chapel Hill (e-mail: bpence@unc.edu ). Dr. Quinlivan, Ms. Heine, and Ms. Edwards are with the Department of Infectious Diseases and Dr. Gaynes is with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill. Dr. Thielman is with the Department of Medicine, Duke University, Durham, North Carolina.
Brian W
BW
Pence
E Byrd
EB
Quinlivan
Amy
A
Heine
Malaika
M
Edwards
Nathan M
NM
Thielman
Bradley N
BN
Gaynes
D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors