Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial

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  • Additional Information
    • Availability:
      American Psychological Association. Journals Department, 750 First Street NE, Washington, DC 20002-4242. Tel: 800-374-2721; Tel: 202-336-5510; Fax: 202-336-5502; e-mail: [email protected]; Web site: http://www.apa.org/publications
    • Peer Reviewed:
      Y
    • Source:
      12
    • Subject Terms:
      Acquired Immunodeficiency Syndrome (AIDS); Rating Scales; Substance Abuse; Intervention; Therapy; Depression (Psychology); Cognitive Restructuring; Patients; Drug Abuse; Comorbidity; Correlation; Behavior Modification; Measures (Individuals)
    • Accession Number:
      10.1037/a0028208
    • ISSN:
      0022-006X
    • 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. Method: 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, gamma[subscript slope] = 0.8873, t(86) = 2.38, p = 0.02; d[subscript GMA-raw] = 0.64, and depression, assessed by blinded assessor: Montgomery-Asberg Depression Rating Scale, F(1, 79) = 6.52, p less than 0.01, d = 0.55; clinical global impression, F(1, 79) = 14.77, p less than 0.001, 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, gamma[subscript slope] = 2.09, t(76) = 2.20, p = 0.03, d[subscript GMA-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. (Contains 3 figures, 1 footnote, and 2 tables.)
    • Abstract:
      As Provided
    • Number of References:
      56
    • Publication Date:
      2013
    • Accession Number:
      EJ992305