Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users

A randomized controlled trial.

Bibliographic Data

ID23382283
AuthorsSteven A Safren (0000-0002-0121-0806, Massachusetts General Hospital), Conall O’cleirigh (0000-0002-5639-5043, Massachusetts General Hospital), Conall M O'Cleirigh, Jacqueline R Bullis (0000-0001-9870-7802, Harvard University), Michael W Otto (0000-0002-8915-7578, Boston University), Michael D Stein (0000-0002-2466-5192, Brown University), M H Pollack (0000-0001-7240-2162, Massachusetts General Hospital)
Year2012
Volume80
Issue3
Pages404-415
Publication date2012-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueJournal of Consulting and Clinical Psychology (JOURNAL)
Journal identifiersISSN: 0022-006X • E-ISSN: 1939-2117
PublisherAmerican Psychological Association (APA) (PUBLISHER)
DOI10.1037/a0028208
PMID22545737
PMCIDPMC3365619
OpenAlexW2169304720
LanguageEN
Citations received57
References cited26

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, 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.

Clinical Global Impression · Cognitive behavioral therapy · Depression (economics) · Discontinuation · Intervention (counseling) · Pill · Placebo · Psychiatry · Randomized controlled trial · Substance abuse · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Pharmacology · Psychology · Substance Abuse Treatment and Outcomes