Improving Depression Among HIV-Infected Adults: Transporting the Effect of a Depression Treatment Intervention to Routine Care.
BACKGROUND
Depression affects 20%-30% of people with HIV. Randomized controlled trials (RCTs) have demonstrated the effectiveness of interventions to improve depression among HIV-infected adults, but typically have highly selected populations which may limit generalizability. Inverse probability of sampling weights (IPSW) is a recently proposed method to transport (or standardize) findings from RCTs to a specific external target population.


METHODS
We used IPSW to transport the 6-month effect of the Measurement-Based Care (MBC) intervention on depression from the SLAM DUNC trial to a population of HIV-infected, depressed adults in routine care in the United States between 2010 and 2014.


RESULTS
In the RCT, MBC was associated with an improvement in depression at 6 months of 3.6 points on the Hamilton Depression Rating scale [95% confidence interval (CI): -5.9 to -1.3]. When IPSW were used to standardize results from the trial to the target population, the intervention effect was attenuated by 1.2 points (mean improvement 2.4 points; 95% CI: -6.1 to 1.3).


CONCLUSIONS
If implemented among HIV-infected, depressed adults in routine care, MBC may be less effective than in the RCT but can still be expected to reduce depression. Attenuation of the intervention effect among adults in routine care reflects the fact that the trial enrolled a larger proportion of individuals for whom the intervention was more effective. Given the burden of depression among HIV-infected adults, more effective interventions to improve depression are urgently needed. However, examining the transportability of trial findings is essential to understand whether similar effects can be expected if interventions are scaled-up.
Departments of *Epidemiology; †Psychiatry, University of North Carolina, Chapel Hill, NC; ‡Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC; §Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA; ‖Department of Medicine, University of California, San Diego, CA; ¶School of Medicine, Johns Hopkins University, Baltimore, MD; #Department of Psychiatry, Massachusetts General Hospital, Boston, MA; **School of Medicine, University of California, San Francisco, CA; ††Departments of Epidemiology and Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI; ‡‡Institute for Community Health Promotion, Brown University, Providence, RI; §§The Fenway Institute, Fenway Health, Boston, MA; and ‖‖Division of Infectious Diseases, University of Alabama-Birmingham, Birmingham, AL.
Angela M
AM
Bengtson
Brian W
BW
Pence
Bradley N
BN
Gaynes
E Byrd
EB
Quinlivan
Amy D
AD
Heine
Julie K
JK
OʼDonnell
Heidi M
HM
Crane
W Christopher
WC
Mathews
Richard D
RD
Moore
Daniel
D
Westreich
Conall
C
OʼCleirigh
Katerina
K
Christopoulos
Matthew J
MJ
Mimiaga
Michael J
MJ
Mugavero
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D003863:Depression / Q000209:etiology* / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000928:Antidepressive Agents
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