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Sponsored by: |
National Institute of Mental Health (NIMH) |
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Information provided by: | National Institute of Mental Health (NIMH) |
ClinicalTrials.gov Identifier: | NCT00338767 |
This study will evaluate the effectiveness of directly observed therapy plus antidepressant medication in improving adherence to antiretroviral drug therapy among HIV-infected homeless and marginally housed people with depression.
Condition | Intervention | Phase |
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HIV Infections Depression |
Behavioral: Directly Observed Therapy (DOT) Drug: Fluoxetine |
Phase II |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study |
Official Title: | Depression Treatment to Improve Antiretroviral Adherence |
Estimated Enrollment: | 150 |
Study Start Date: | January 2001 |
Estimated Study Completion Date: | October 2008 |
Estimated Primary Completion Date: | October 2008 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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Treatment: Experimental
Participants receiving storefront directly observed therapy of anti-depressants
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Behavioral: Directly Observed Therapy (DOT)
DOT includes storefront directly observed therapy of prescribed anti-depressants. Participants will meet with a study psychiatrist, who will prescribe an appropriate antidepressant medication. Subsequent meetings with the psychiatrist will occur weekly for the first 3 weeks, and then monthly for the duration of the study. Additionally, participants will have DOT visits every weekday morning for 1 month to take their antidepressant medications. After the first month, DOT visits will occur weekly or biweekly, depending on the medication regimen.
Drug: Fluoxetine
Medication treatment includes flouxetine for treatment of depression.
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Control: No Intervention
Participants receiving referral to mental health follow-up with the UCSF AIDS Health Project
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Antiretroviral drug therapy (ART) is a type of medication treatment for HIV that impairs the virus's ability to multiply. When used properly, it has been shown to be successful in reducing HIV-related deaths. A 95% adherence rate to ART is required to adequately suppress the virus and prevent transmission. Low ART adherence rates are often linked to depression, which is especially common in HIV-infected homeless or marginally housed people. In these cases, treatment with antidepressant medication may be useful in improving ART adherence. Directly Observed Therapy (DOT), in which medication intake is closely monitored, is another method of enhancing treatment compliance. DOT improved treatment adherence during the tuberculosis epidemic of the 1990s, and is now gaining recognition as a model for improving ART adherence. This study will evaluate the effectiveness of combining DOT and antidepressant medication in improving ART adherence among HIV-infected homeless and marginally housed people with depression.
Participants in this 9-month, open-label study will be randomly assigned to a treatment group or a control group. The control group will be given the phone number of the University of California, San Francisco AIDS Health Project (AHP) to call and make an appointment with a psychiatrist. Participants who attend appointments will be evaluated to determine their mental health status. Participants who are deemed to benefit from treatment will be scheduled for regular appointments at the AHP, but will be responsible for administering their own medications. The treatment group will meet with a study psychiatrist, who will prescribe an appropriate antidepressant medication. Subsequent meetings with the psychiatrist will occur weekly for the first 3 weeks, and then monthly for the duration of the study. Additionally, participants will have DOT visits every weekday morning for 1 month to take their antidepressant medications. After the first month, DOT visits will occur weekly or biweekly, depending on the medication regimen. If an individual does not attend a visit, study staff will try to locate the individual in the neighborhood to deliver the medication. Medication for the weekend will be prepared by study staff, but participants will take it on their own at home. For the last 2 months of the study, DOT visits will occur once monthly, at which time participants will receive their entire month's supply of medication.
Participants in both groups will be asked to report to the study site weekly for 6 months and then monthly for the final 3 months to provide an update on the status of their housing, healthcare providers, case managers, and HIV medications. Additional interviews about housing, income, use of health services, drug use, sexual practices, and mental health will occur at the beginning of the study and three more times throughout the study. Blood tests will be performed monthly to assess viral load, and every 3 months to assess CD4 count. Participants taking HIV medications will be visited by study staff at home once a month so that use of HIV medications can be determined. At the end of the study, participants in the control group may continue receiving treatment at the AHP. Six months after the end of the study, participants in the treatment group may also begin treatment with a psychiatrist at the AHP.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Contact: David R. Bangsberg, MD, MPH | 415-206-3462 | db@epi-center.ucsf.edu |
Contact: Matthew D. Reynolds | 415-476-2181 ext 2 | mreynolds@epi-center.ucsf.edu |
United States, California | |
UCSF Market Street Study Site | Recruiting |
San Francisco, California, United States, 94102 | |
Contact: Matthew D. Reynolds 415-476-2181 ext 2 mreynolds@epi-center.ucsf.edu | |
Principal Investigator: David R. Bangsberg, MD, MPH |
Principal Investigator: | David R. Bangsberg, MD, MPH | University of California, San Francisco |
Responsible Party: | University of California, San Francisco ( David R. Bangsberg, MD, MPH Prinicpal Investigator ) |
Study ID Numbers: | R01 MH63011, DAHBR AZ-M |
Study First Received: | June 16, 2006 |
Last Updated: | January 2, 2008 |
ClinicalTrials.gov Identifier: | NCT00338767 |
Health Authority: | United States: Federal Government |
AIDS DOT Directly Observed Therapy |
Sexually Transmitted Diseases, Viral Depression Acquired Immunodeficiency Syndrome Depressive Disorder Serotonin Immunologic Deficiency Syndromes Behavioral Symptoms |
Virus Diseases Fluoxetine HIV Infections Mental Disorders Sexually Transmitted Diseases Mood Disorders Retroviridae Infections |
RNA Virus Infections Neurotransmitter Uptake Inhibitors Neurotransmitter Agents Slow Virus Diseases Immune System Diseases Molecular Mechanisms of Pharmacological Action Physiological Effects of Drugs Psychotropic Drugs Infection |
Serotonin Uptake Inhibitors Pharmacologic Actions Serotonin Agents Therapeutic Uses Lentivirus Infections Antidepressive Agents, Second-Generation Central Nervous System Agents Antidepressive Agents |