HIV:n sitoutumisen ja nuorten masennuksen tuki (HEADS-UP) (HEADS-UP)
This pilot study will individually randomize 105 adolescents living with HIV 1:1:1 to standard of care, adapted intervention, or enhanced intervention. The intervention is called the Friendship Bench Intervention is a counseling intervention for depression and engagement in HIV care.
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
Sub-Saharan Africa is home to the largest population of adolescents living with HIV (ALWH). Engaging ALWH in HIV care is challenging and reflected in lower rates of viral suppression and higher rates of loss to follow-up as compared to adults in the region. Depression has been identified as a significant barrier to initiating and remaining in HIV care. Indeed, this is the case for ALWH in Malawi where estimates of viral suppression range from 40%-78% and estimates of depression range from 18-26%. Resource-appropriate interventions that improve depression and address engagement in HIV care for ALWH are urgently needed.
The Friendship Bench (FB) is an evidence-based depression counseling intervention delivered by trained, supervised lay health workers. It is proven to reduce depression in the general population in low-resource settings but has not been adapted to be youth-friendly or enhanced with peer support to facilitate engagement in HIV care among ALWH. FB is based on problem-solving therapy, which offers an ideal framework for youth-friendly adaption and integration of retention peer support into a proven depression treatment model.
The long-term goal of the study team is to adapt, test, and scale up resource-appropriate interventions to reduce depression and improve engagement in HIV care amongst ALWH. The specific aims are: 1) to conduct formative research for youth-friendly adaptation and peer support enhancement of FB; 2) to adapt the evidence-based FB protocol to meet the developmental and contextual needs of ALWH and enhance this adapted FB protocol with peer support to facilitate HIV care engagement among ALWH; and 3) to determine the feasibility, fidelity, and acceptability of the Adapted and Enhanced FB protocols to improve depression and engagement in HIV care among ALWH. For the latter, a 3-arm individually randomized pilot study will be conducted to compare the adapted FB and the enhanced FB to standard care. The proposed aims pave the way for a R01 application to test the adapted and enhanced Friendship Bench interventions in a cluster randomized controlled trial and represent an important step forward towards improving depression among ALWH.
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Todellinen)
Ilmoittautuminen
Vaihe
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskelupaikat
-
-
-
Lilongwe, Malawi
- UNC Project Malawi
-
Lilongwe, Malawi
- Area 18 Health Centre
-
Lilongwe, Malawi
- Area 25 Health Centre
-
Lilongwe, Malawi
- Kawale Health Centre
-
Lilongwe, Malawi
- Lighthouse Health Centre
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- age 13-18
- diagnosed with HIV (vertically or horizontally)
- scored ≥ 13 on the self-reported and previously used BDI-II
- living in the clinic's catchment area with intention to remain for > 1 year
- willing to provide consent (age 18 or 16-17 years old and married (emancipated minors per Malawi law) or assent with parental consent (age 13-17)
Exclusion Criteria:
- Less than 13 or greater than 18 years of age
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
|---|---|
|
Active Comparator: Standard of Care (SOC)
35 adolescents living with HIV seeking HIV care at participating clinics in Lilongwe, Malawi will be enrolled in this study arm during study recruitment. Enhanced usual care will include general training of the HIV providers and clinics about common mental disorder (CMD) identification and management, and feedback to the HIV provider of the status of their enrolled patient to allow follow-up per the clinic's standard care. Enhanced usual care will included a mental health evaluation provided by a rained study nurse; brief supportive counseling; information, education, and support on depression; and (if indicated) facilitation of referral to the clinic's psychiatric nurse or mental health clinic or to the tertiary care hospital. |
Participants randomized to this arm will received enhanced standard of care. |
|
Kokeellinen: Adapted Friendship Bench (AFB)
35 adolescents living with HIV seeking HIV care at participating clinics in Lilongwe, Malawi will be enrolled in this study arm during study recruitment. Individuals enrolled in this arm will receive 6 weekly counseling sessions per the AFB protocol. |
Participants randomized to this arm will receive the Adapted Friendship Bench protocol delivered by a trained counselor. |
|
Kokeellinen: Enhanced Friendship Bench (EFB)
35 adolescents living with HIV seeking HIV care at participating clinics in Lilongwe, Malawi will be enrolled in this study arm during study recruitment. Individuals enrolled in this arm will receive 6 weekly counseling sessions and peer support per the EFB protocol. |
Participants randomized to this arm will receive the Enhanced Friendship Bench protocol delivered by a trained counselor and a peer supporter. |
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Number of Participants Enrolled of the Participants Approached (Intervention Feasibility)
Aikaikkuna: Baseline
|
This measure is the ability to successfully enroll adolescents living with HIV (ALWH) in the pilot trial. Feasibility will be evaluated by measuring the number of participants enrolled of the participants approached. |
Baseline
|
|
Number of Participants Retained in the Study (Intervention Feasibility)
Aikaikkuna: 12 months
|
This measure of feasibility will be measured as the ability to retain adolescents living with HIV (ALWH) in the pilot trial. Feasibility will be evaluated by measuring the number of participants retained in the study (number of patients enrolled at baseline who are still enrolled in the trial), through study completion. |
12 months
|
|
Number of Participants Who Received Full Intervention (Intervention Feasibility)
Aikaikkuna: 12 Months
|
The number of participants who attended all 6 planned Friendship Bench counseling sessions. |
12 Months
|
|
Number of Sessions Meeting Fidelity Threshold (Intervention Fidelity)
Aikaikkuna: 12 Months
|
Fidelity to content for sessions will be assessed by a member of the research team using a checklist of intervention characteristics. Scoring either 'meeting expectations' or 'exceeding' expectations' on at least 80% of applicable checklist items during each session will be considered fidelity to the intervention protocol. |
12 Months
|
|
Overall Satisfaction Among Participants (Intervention Acceptability)
Aikaikkuna: 6 Months
|
Intervention acceptability was measured as the number of participants who would either probably or definitely recommend the Friendship Bench to other adolescents living with HIV with depression. Responses were measured on a 4-point Likert scale-- 1 indicates high satisfaction and 4 indicates high dissatisfaction. |
6 Months
|
Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Change in Depression Symptoms From Baseline
Aikaikkuna: Baseline,12 months
|
Change in depression symptoms from baseline will be evaluated using Beck's Depression Inventory (BDI-II). The Beck Depression Inventory (BDI-II) is a 21-item patient self-report measure of the severity of depression. Each item is rated on a 4-point scale ranging from 0 to 3. The minimum total score is zero and the maximum total score is 63. A total score of 0-13 is considered nondepressed, 14-19 represents mild depression, 20-28 represents moderate depression, and 29-63 represents severe depression. Lower scores represent better outcomes. Scores reported are change in symptoms relative to baseline. |
Baseline,12 months
|
|
Number of Adolescents Living With HIV Who Attended at Least One Appointment Per Quarter
Aikaikkuna: 12 months
|
Number of adolescents living with HIV who attended at least one appointment per quarter. |
12 months
|
|
Number of Participants Achieving HIV Viral Suppression
Aikaikkuna: 12 months
|
Number of participants achieving HIV viral suppression at 12 months (HIV RNA no detect + <839 copies/mL) |
12 months
|
Yhteistyökumppanit ja tutkijat
Sponsori
Sponsori
Yhteistyökumppanit
Yhteistyökumppanit
Tutkijat
Tutkijat
- Päätutkija: Bradley N Gaynes, MD, University of North Carolina, Chapel Hill
- Päätutkija: Nivedita L Bhushan, PhD, RTI International
Julkaisuja ja hyödyllisiä linkkejä
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Opiskelun aloitus
Ensisijainen valmistuminen (Todellinen)
Ensisijainen valmistuminen
Opintojen valmistuminen (Todellinen)
Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Ensimmäinen Lähetetty
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin päivitys julkaistu
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Muita asiaankuuluvia MeSH-ehtoja
- Veren välityksellä leviävät infektiot
- Urogenitaaliset sairaudet
- Sukuelinten sairaudet
- Mielenterveyshäiriöt
- Käyttäytymisoireet
- Infektiot
- RNA-virusinfektiot
- Virussairaudet
- Tartuntataudit
- Sukupuolitaudit, virus
- Sukupuolitaudit
- Lentivirus-infektiot
- Retroviridae-infektiot
- Immunologiset puutosoireyhtymät
- Käyttäytyminen
- Ahdistuneisuushäiriöt
- HIV-infektiot
- Masennus
- Immuunijärjestelmän sairaudet
- Nuorten käyttäytyminen
- Terveyspalveluiden hallinto
- Terveydenhuollon laatu, saatavuus ja arviointi
- Terveydenhuollon laatu
- Laatuindikaattorit, terveydenhuolto
- Hoidon taso
Muut tutkimustunnusnumerot
Muut tutkimustunnusnumerot
- 23-2439
- R34MH130232 (Yhdysvaltain NIH-apuraha/sopimus)
Yksittäisten osallistujien tietojen suunnitelma (IPD)
Aiotko jakaa yksittäisten osallistujien tietoja (IPD)?
IPD-suunnitelman kuvaus
Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with the University of North Carolina at Chapel Hill (UNC).
IPD-jaon aikakehys
beginning 9 and continuing for 36 months after publication
IPD-jaon käyttöoikeuskriteerit
Investigator has approved IRB, IEC, or REB and an executed data use/sharing agreement with UNC.
Lääke- ja laitetiedot, tutkimusasiakirjat
Tutkii yhdysvaltalaista FDA sääntelemää lääkevalmistetta
Tutkii yhdysvaltalaista FDA sääntelemää laitetuotetta
Nämä tiedot haettiin suoraan verkkosivustolta clinicaltrials.gov ilman muutoksia. Jos sinulla on pyyntöjä muuttaa, poistaa tai päivittää tutkimustietojasi, ota yhteyttä register@clinicaltrials.gov. Heti kun muutos on otettu käyttöön osoitteessa clinicaltrials.gov, se päivitetään automaattisesti myös verkkosivustollemme .