- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT00218634
Skills Based Counseling for Adherence and Depression in HIV+ Methadone Patients - 1
CBT for Depression & Adherence in HIV Methadone Patients
Patients with HIV, depression, and opioid-dependence are at high risk for poor health outcomes. This is a two-arm randomized controlled trial of cognitive-behavioral therapy for depression and HIV medication adherence in patients with opioid dependence who are receiving methadone maintenance treatment. The project is based on our pilot work with close attention to NIDA guidelines for a staged approach to treatment development and testing (Rounsaville et al., 2001).
Depression is highly comorbid with both HIV infection and with opioid dependence. Depression and substance abuse are both associated with poor adherence to antiretroviral medications. Patients with HIV, depression, and opioid dependence are at high risk for poor health outcomes. Cognitive-behavioral therapy is the most widely studied and efficacious psychosocial intervention for depression; and research by the PI and others has shown that cognitive-behavioral interventions have been successful in promoting adherence to HIV medications.
Studieoversikt
Status
Intervensjon / Behandling
Detaljert beskrivelse
Symptoms of depression (i.e. low motivation, poor concentration, loss of interest, sad mood, suicidal ideation) that occur in the context of substance abuse or dependence can interfere with self-care behaviors necessary for maintaining HIV care, as well as interfere with potential benefit from an intervention that focuses on adherence alone. We hypothesize that teaching skills to cope with depression will improve the outcome from an adherence intervention to promote healthier living with HIV, in HIV+ opioid dependent individuals in methadone maintenance treatment.
Overview of Research Plan. Patients who are HIV positive and who are receiving methadone maintenance for opioid dependence will be randomized to treatment with either: (1) CBT, a combination of CBT for depression and HIV medication adherence, including a single session intervention for HIV medication adherence (Life-Steps, Safren et al., 2001) in conjunction with physician feedback regarding baseline study assessments or (2) the single session intervention for HIV medication adherence (Life-Steps, Safren et al., 2001) in conjunction with physician feedback regarding baseline study assessments. Participants will be followed for one-year post-randomization.
Studietype
Registrering (Faktiske)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
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Massachusetts
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Boston, Massachusetts, Forente stater, 02114
- Massachusetts General Hospital
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- HIV seropositive
- Currently enrolled in methadone maintenance treatment for at least one month
- Current major or subsyndromal depression (subsyndromal depression is defined by major depression that does not meet full diagnostic criteria but with a clinical global impression of severity (CGI-S) of 2 (mildly ill))
- Is prescribed antiretroviral therapy for HIV and therefore under the care of a primary care provider.
- Between the ages of 18 and 65.
Exclusion Criteria:
- Active untreated, unstable, major mental illness (i.e., untreated psychosis or mania), or other Axis I psychiatric disorders (other than depression) that would interfere with the ability to participate (i.e. CGI-S >6)
- Unable or unwilling to provide informed consent.
- Currently in cognitive behavioral therapy for depression.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Enkelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: CBT-AD
Cognitive behavioral therapy for adherence and depression
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Cognitive behavioral therapy for adherence and depression consisting of 1 session focusing on adherence and 8 sessions consisting of cognitive behavioral therapy for medication adherence and depression.
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Aktiv komparator: ETAU
Enhanced treatment as usual
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Enhanced treatment as usual consisting of 1 session focused on adherence (the same session as the CBT-AD intervention) and 8 sessions for participants to complete self-reports and collect adherence data.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Percent Medication Adherence at 3-month Follow-up Assessment
Tidsramme: 3-month assessment
|
Post-treatment assessment in adherence to HIV medication.
Doses taken were assessed by downloading information from the electronic pill cap and corroborated by participant self-report.
Adherence was calculated as the number of doses taken over the time period divided by the number of doses prescribed.
|
3-month assessment
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Percent Medication Adherence at 12-month Follow-up Assessment
Tidsramme: 12-month follow-up assessment
|
Follow-up assessment in adherence to HIV medication.
Doses taken were assessed by downloading information from the electronic pill cap and corroborated by participant self-report.
Adherence was calculated as the number of doses taken over the time period divided by the number of doses prescribed.
|
12-month follow-up assessment
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Clinician-assessed Depression Rating at 3 Month Follow-up Assessment
Tidsramme: 3 month follow-up
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Depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) by a clinical interviewer blind to participants' study condition.
The scale ranges from 0 to 60 with 7-19 indicating mild depression and 20-34 indicating moderate depression.
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3 month follow-up
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HIV Viral Load at 12-month Follow-up Assessment
Tidsramme: 12-month follow-up assessment
|
HIV plasma RNA (log HIV viral load)at the 12-month follow-up assessment.
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12-month follow-up assessment
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CD4+ Lymphocyte Count at 12-month Follow-up Assessment.
Tidsramme: 12-month follow-up assessment
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CD4+ lymphocyte cell count at 12-month follow-up assessment.
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12-month follow-up assessment
|
Clinician-assessed Depression at 12-month Follow-up Assessment
Tidsramme: 12-month follow-up assessment
|
Depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) by a clinical interviewer blind to participants' study condition.
The scale ranges from 0 to 60 with 7-19 indicating mild depression and 20-34 indicating moderate depression.
|
12-month follow-up assessment
|
HIV Viral Load at 3-month Follow-up Assessment
Tidsramme: 3-month assessment
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HIV plasma RNA (log HIV viral load)at the 3-month follow-up assessment.
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3-month assessment
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CD4+ Lymphocyte Count at 3-month Follow-up Assessment.
Tidsramme: 3-month assessment
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CD4+ lymphocyte cell count at 3-month follow-up assessment.
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3-month assessment
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Samarbeidspartnere og etterforskere
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Steven Safren, Ph.D., Massachusetts General Hospital
Publikasjoner og nyttige lenker
Studierekorddatoer
Studer hoveddatoer
Studiestart
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- NIDA-18603-1
- R01DA018603 (U.S. NIH-stipend/kontrakt)
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