HIV Translating Initiatives for Depression Into Effective Solutions (HI-TIDES)
VA Office of Research and Development
Information provided by (Responsible Party)
VA Office of Research and Development
First received: March 16, 2006
Last updated: November 10, 2016
Last Verified: November 2016
History of Changes
This study is a randomized trial designed to test and refine a collaborative care model for treating depression in VA patients with HIV.
Behavioral : Collaborative Care Interventions
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||HIV Translating Initiatives for Depression Into Effective Solutions|
Further study details as provided by VA Office of Research and Development:
Primary Outcome Measures
Percentage of Participants With Depression Treatment Response
[ Time Frame: 6 months ]
Depression symptom severity over the past two weeks was measured using the Hopkins Symptom Checklist (SCL-20). The SCL-20 includes the 13-item depression scale plus 7 depression-related items from the Hopkins Symptom Checklist-90-Revised. The items are scored from 0 to 4 and averaged to provide a mean depression severity score from 0 to 4. Depression treatment response at 6-months was defined as a 50% decrease in mean SCL-20 score compared to baseline.
|Study Start Date:||February 2007|
|Study Completion Date:||November 2016|
|Primary Completion Date:||July 2009 (Final data collection date for primary outcome measure)|
Arm 1: Collaborative Care Intervention
HIV patients were screened for depression and the screener results were available to HIV clinicians. Depressed HIV patients received collaborative care intervention.
Collaborative Care Interventions
Patients in the intervention group will be supported by a depression collaborative care team that will include a depression nurse care manager, clinical pharmacist, and psychiatrist. The depression nurse care manager will evaluate depression symptom severity, antidepressant side effects, depression and HIV medication adherence every two weeks over the phone during the acute phase of treatment and will record these results in CPRS. After a 50% improvement in depression severity, the intervention subject will move into the continuation phase of treatment and the patient will be contacted every four weeks by the depression nurse case manager.
Arm 2: Usual Care
HIV patients were screened for depression and the screener results were available to HIV clinicians. Depressed HIV patients received usual care.
Background: Depression is the most common mental disorder in HIV infected patients. Despite the availability of efficacious treatments for depression, evidence suggests that it is under-diagnosed and under-treated in routine HIV care. To address this problem, the investigators will adapt and implement a collaborative stepped-care model for depression treatment in HIV clinics. This proposal builds on past success of the TIDES/WAVES programs used in VA primary care. The project (HI-TIDES or HIV Translating Initiatives for Depression into Effective Solutions) will implement the primary care collaborative care model for depression treatment in HIV clinics using evidence-based implementation strategies. Objectives: The objectives of this proposal are to: 1) Develop and evaluate the process of adapting, implementing, and sustaining collaborative care for depression in VA HIV clinics, 2) Compare the quality of depression care and the clinical effectiveness of HI-TIDES to usual care in the HIV clinics, and 3) Evaluate the cost-effectiveness of patients assigned to HI-TIDES relative to patients assigned to usual care in HIV clinics. Methods: The implementation framework for this proposal is primarily informed by the Rogers diffusion of innovation model, Simpson Transfer Model, and the PRECEDE model. The VA and American Psychiatric Association Practice Guidelines inform the stepped care collaborative model intervention as source documents for summarizing the evidence for depression treatment for the general population. An expert panel will be convened to rate the quality of available evidence for depression treatment in the context of HIV. Patients will be recruited from VA HIV clinics: Little Rock, Atlanta, and Houston. The intervention will be randomized at the level of the patient. The investigators expect to recruit a total of 140 intervention and 140 usual care patients. Patients in the intervention group will be supported by a depression collaborative care team that will include a depression nurse care manager, clinical pharmacist, and psychiatrist. The depression nurse care manager will evaluate depression symptom severity, antidepressant side effects, depression and HIV medication adherence every two weeks over the phone during the acute phase of treatment and will record these results in the VA electronic medical record. After a 50% improvement in depression severity, the intervention subject will move into the continuation phase of treatment and the patient will be contacted every four weeks by the depression nurse case manager. A formative evaluation will occur during start-up and throughout the implementation of the intervention. A summative evaluation will document the effectiveness and cost-effectiveness of the intervention using an intent to treat analysis plan. Findings: No results at this time. Status: Start-up activities. Impact: The proposed study is highly relevant to the VA and the Veterans it serves for many reasons. First, the majority of VA patients with HIV are not seen in the primary care clinics and therefore will not benefit from VA's efforts in primary care settings to improve depression identification and treatment. Second, in addition to the negative outcomes of depression generally, depression in HIV patients is associated with additional negative outcomes including accelerated HIV disease progression, decreased immune system functioning, and premature death. Third, directly moving collaborative depression care from primary care clinics to HIV clinics is likely to fail for several reasons including the comorbidities associated with depressed HIV patient and the potential for drug-drug interactions. The proposed project will address these gaps and provide effectiveness and cost-effectiveness analyses to inform decisions about larger scale implementation of the HI-TIDES intervention.Eligibility
|Ages Eligible for Study:||18 Years to 75 Years|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- current 9-item Patient Health Questionnaire (PHQ-9) score of 10 or more and
- current treatment in the HIV clinic.
- patients who do not have access to a telephone,
- patients with current suicidal ideation,
- patients with significant cognitive impairment as indicated by a score < 10 on the HIV Dementia Scale, and
- patients with a chart diagnosis of schizophrenia.
Contacts and LocationsChoosing to participate in a study is an important personal decision.Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00304915
Locations Show More
|United States, Arkansas|
|Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR|
|No. Little Rock, Arkansas, United States, 72114-1706|
|United States, Georgia|
|Atlanta VA Medical and Rehab Center, Decatur, GA|
|Decatur, Georgia, United States, 30033|
|United States, Texas|
|Michael E. DeBakey VA Medical Center, Houston, TX|
|Houston, Texas, United States, 77030|
Sponsors and CollaboratorsVA Office of Research and Development
|Principal Investigator:||Jeffrey M Pyne, MD||Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR|
|Responsible Party:||VA Office of Research and Development|
|ClinicalTrials.gov Identifier:||NCT00304915 History of Changes|
|Other Study ID Numbers:||MNT 05-152|
|Study First Received:||March 16, 2006|
|Last Updated:||November 10, 2016|
|Individual Participant Data|
|Plan to Share IPD:||Yes|
Keywords provided by VA Office of Research and Development:HIV, depression
patient care management
patient care team
Additional relevant MeSH terms:
ClinicalTrials.gov processed this data on October 17, 2017
This information is provided by ClinicalTrials.gov.