A new treatment method for HIV-positive people with depression

A new treatment method for HIV-positive people with depression

Project

There is a group of people living with HIV who also suffer from depression. Leiden University researchers, Dr. Vivian Kraaij and Dr. Nadia Garnefski developed an Internet-supported self-help program for people with HIV (PLH) who suffer from mild to moderate depression. The effectiveness of the program was tested in the PhD project of Drs. Sanne van Luenen. The program was found to be effective in reducing symptoms of depression, Therefore it will be implemented as a new form of treatment for people living with HIV and depression.

Project details

Time frame
04 January 2014 - 28 February 2019
Budget
€ 246,365
Active in
Netherlands

Objectives

The aim of this project was to develop and evaluate an evidence-based Internet-supported self-help program for PLH suffering from mild to moderate depressive symptoms, aimed at lowering depression (available in Dutch and English). Based on empirical evidence, the content of the program contains 4 main components: activation, relaxation, changing maladaptive cognitions, and the attainment of new personal goals. Techniques of Cognitive Behavioral Therapy, Motivational Interviewing, psycho-education, and homework assignments are integrated. Participants work on the program for 6 weeks. A coach provides motivation and support on a weekly basis, by telephone.
A Randomized Controlled Trial was performed, with a pretest and three posttests. In total, 188 participants were included, who were recruited in 23 HIV treatment centers. Participants randomized to the Internet-supported group followed the six-week program. Participants randomized to the control group received attention only by a weekly telephone call with a personal coach. The latter group received the program after completion of the second posttest. The main question was to investigate the effectiveness of this new Internet-supported self-help program by comparing people who followed the program with people on the waiting list on reduction of depressive symptoms. Secondary questions were to investigate whether the program was more effective for certain subgroups than for others, and whether factors mediated treatment outcome (such as changes in coping patterns and/or goal adjustment). The main results showed that the reduction in depressive symptoms was significantly larger in the intervention group than in the control group, both on the short term and on the longer term. Secondary questions are currently under study. These results show that this guided internet-based intervention is effective for the treatment of depressive symptoms. The next step will be implementation. The expected end date is Spring 2019.

Community groups

150 people living with HIV and mild depression

Background

Nowadays many PLH are successfully treated through strict adherence to antiretroviral medication. However, PLH continue to experience psychological distress from disease-specific and general life stressors associated with living with a chronic, highly stigmatized, disease. Consequently, PLH are at an increased risk of developing psychological disorders. Mood disturbances are often viewed as one of the most common psychiatric symptoms reported by PLH. A systematic review showed that HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Furthermore, PLH with psychiatric disorders have been found to be at greater risk for poor adherence to antiretroviral therapy and for HIV-related morbidity and mortality. Consequently, improvement of well-being for PLH should be a major treatment goal.

A number of psychological programs have been developed for PLH, of which the majority employs techniques of Cognitive Behavioral Therapy (CBT). All of these programs involve group-based or individualized face to face contact, and consist of multiple sessions. Overall, psychological interventions for PLH significantly improve mental health and quality of life. There is also evidence suggesting intervention effects on medication adherence.
A disadvantage of these intervention programs is their high costs and the demands they place on patients as well as professionals in terms of arranging and scheduling visits. Furthermore, for HIV-specific programs, stigma is a significant barrier to service delivery and utilization. A self-help program could be a way to overcome these disadvantages and barriers.

A number of psychological programs have been developed for PLH, of which the majority employs techniques of Cognitive Behavioral Therapy (CBT). All of these programs involve group-based or individualized face to face contact, and consist of multiple sessions. Overall, psychological interventions for PLH significantly improve mental health and quality of life. There is also evidence suggesting intervention effects on medication adherence.
A disadvantage of these intervention programs is their high costs and the demands they place on patients as well as professionals in terms of arranging and scheduling visits. Furthermore, for HIV-specific programs, stigma is a significant barrier to service delivery and utilization. A self-help program could be a way to overcome these disadvantages and barriers.

Goals

Radical reduction in the Big Six STIs and 0 new HIV infections
100%
Contributed within this project

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