Depression, HIV
Conditions
Keywords
HIV, Adherence, Mental health, Depression, Women, Mobile phone technology, eHealth, India
Brief summary
The overall objective of this project is to demonstrate that a low cost, cell phone-delivered intervention is a promising, feasible and acceptable way to improve the prevention and treatment outcomes of women in India who are affected by HIV and inter-related mental health and psychosocial risk factors.
Detailed description
The overall objective of this project is to demonstrate that a low cost, cell phone-delivered intervention is a promising, feasible and acceptable way to improve the prevention and treatment outcomes of women in India who are affected by HIV and inter-related mental health and psychosocial risk factors. Over the past decade there have been dramatic improvements in HIV prevention and access to life-saving antiretroviral therapy (ART). Yet, deficits in adherence to the spectrum of HIV care pose significant barriers to success. Women are at a particular disadvantage. Gender inequality, physical and situational factors place many women at increased risk for HIV acquisition and poor mental health and interrelated psychosocial co-factors (depression, gender-discrimination, violence, lack of social support, etc.) that are well established correlates of poor adherence and retention in HIV care. Recent studies have shown alarmingly high rates of loss to follow-up for these women, particularly in the transition after delivery, between PMTCT and lifelong HIV care services. Preliminary work indicates that a theory-guided adherence phone intervention that can be easily integrated and sustained as a component of routine ART Centre services is well suited for the target population, but it needs to be adapted to the sociocultural context. Following initial formative work to refine the intervention for delivery in India, clinic nurses will be trained to deliver the intervention, and the feasibility, fidelity and preliminary efficacy of the novel application of the intervention will be evaluated in a randomized trial. After baseline assessment, women (n=120) will be randomly assigned to treatment as usual (TAU) or TAU plus the phone intervention (delivered over 16 weeks) and outcomes will be evaluated at 6, 14, 24, 36 weeks post-randomization. If the promising mobile phone intervention developed and pilot tested in this project shows promise in this Phase 1 study as we expect, the efficacy and cost of the intervention will then be evaluated in a large scale, multi-site study. If successful, an extremely practical approach will be available to improve the prevention and treatment outcomes of women with HIV and co-morbid mental health problems in India.
Interventions
BEHAVIORALNurse-delivered mobile phone counseling intervention
Multi-dimensional, patient-centered counseling approach used to build patient-provider rapport, establish sources of support, and enable and empower problem solving to address inter-related, multi-tiered barriers to care.
BEHAVIORALTreatment as Usual
Routine HIV clinic-based counseling
Sponsors
National Institute of Mental Health and Neuro Sciences, India
National Institute of Mental Health (NIMH)
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* HIV+ women starting ART * Willing to be contacted by mobile phone * Speaks English or Hindi or Kannada * Screens positive for depressive symptoms or psychosocial risk factors * Able to provide informed consent
Exclusion criteria
* Unable to participate in study visits * Any condition that, in the opinion of the site investigator, would compromise the candidate's ability to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Viral load | 6 months post-randomization | HIV-1 RNA copies per millilitre of blood plasma |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Medication adherence | 6 weeks post-randomization | Self-reported adherence to HIV medications |
| Mental health (Survey) | 6 weeks post-randomization | Survey measures of symptoms of depression, anxiety and cognitive representation of illness |
| Mental health (survey) | 14 weeks post-randomization | Survey measures of symptoms of depression, anxiety and cognitive representation of illness |
| Mental health | 24 weeks post-randomization | Survey measures of symptoms of depression, anxiety and cognitive representation of illness |
| Medication adherence (Self-reported) | 14 weeks post-randomization | Self-reported adherence to HIV medications |
Other
| Measure | Time frame | Description |
|---|---|---|
| Feasibility and acceptability (Protocol specific tools) | 6 weeks post-randomization | Protocol specific tools will be used to measure feasibility and user acceptability The assessment will include: 1) The ratio of eligible study participants to those enrolled; 2) Number of scheduled study visits completed at 6, 14, 24, and 36 weeks; 3) Attrition between baseline and follow-up; 4) Reason for premature drop-out; 5) Number of phone calls that were made on schedule; 6) Level of participation in intervention sessions including the total number sessions, number of sessions completed without break offs, number of break offs, length (minutes) of sessions; 7) Congruence of topic/content discussed on calls with protocol; 8) Patient and study nurse satisfaction with intervention content, mode of delivery, and protocol. |
Countries
India
Outcome results
None listed