Implementing depression and adherence treatment in S. Africa HIV care

Active Project Grant Awarded Last action

Award ID
R01MH136972
Recipient
Awarding agency
Obligated
$4,410,813

Award facts

Assistance listing
93.242 Mental Health Research Grants
Completion date 46% complete
Place of performance
South Miami, FL 33146, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Background: evidence-based treatments for depression and treatment adherence in persons with HIV (PWH) are not reaching a sufficient number of PWH who need them, and untreated depression may hinder all aspects of the HIV care cascade; especially rates of viral suppression. This is particularly dire in south africa, which has the highest number of HIV cases in the world,1 comorbid depression is approximately 30%, and only 0.28 psychiatrists and 0.32 psychologists per 100,000 people are available.2 prior work: we developed cognitive behavioral therapy for adherence and depression (CBT-ad) and found IT to be efficacious and effective for treating depression and improving art adherence.3-8 in SA specifically, we demonstrated superior effects of CBT-ad on depression, adherence, and viral undetectability in an task-shared effectiveness study with nurse interventionists.9 CBT-ad was also cost-effective in this context.10 design. This is a proposal for a two-arm hybrid type 3 effectiveness-implementation study using a clinic randomized parallel cluster RCT design. Across 10 clinics, we will compare a core set and enhanced set of implementation strategies to increase the reach of evidence-based treatments to patients with HIV and depression in south africa (SA). The proposed strategies and outcomes are based on our implementation research logic model (IRLM)11 which we developed from our preliminary community-engaged work in SA. Our IRLM links key determinants to implementation strategies from the expert recommendations for implementing change (ERIC).12 implementation strategies and outcomes: in both study arms, core strategies include expanding the nurse cadre role, trainings to decrease mental health stigma, training in depression and depression screening, education about existing evidence-based depression treatments (including our flip-book treatment manual for CBT-ad, and referring patients to available evidence-based depression treatments - therapy or psychopharmacotherapy). In the enhanced arm, strategies also include providing more resource-intensive on- site training, "train-the-trainer" strategies in CBT-ad, and clinical supervision of the nurse interventionists for one year. Using the RE-aim framework,13 the primary implementation outcome is "reach", the proportion of patients who start an evidence-based treatment for depression (i.e., CBT-ad and/or psychopharmacotherapy), though we will also examine, effectiveness, adoption, implementation, and maintenance. Effectiveness outcomes are the percent of patients who show clinical improvement in depression and the percent who attain viral undetectability within one year. Finally, we will compare high and low reach clinics to further inform tailored implementation strategies for uptake and maintenance. Impact: CBT-ad is the only treatment that impacted both HIV and depression outcomes in a prospective trial, has been task-shared in the S. African context, is cost-effective, and has a set of implementation strategies based on community partnerships and our prior work. The proposed study will provide a replicable implementation model.

Transactions

Action Obligated Date
Amendment $359,521
Amendment $587,515
Amendment $587,515
Amendment $359,521
Amendment $589,711
Amendment $0
Amendment $0
Amendment $0
Amendment $0
Amendment $0
Amendment $0
Amendment $963,515
Original award $963,515
Show all 13

Subawards

Subrecipient Amount Awarded
Kobenhavns Universitet Dr. Andersen is a clinical psychologist who served as the project director of our previous trial and she has experience with similar trials conducted at UCT… $42,794
University Of Cape Town The research team at the University of Cape Town's Department of Psychiatry and Mental Health will be led by Principal Investigator, Dr. John Joska. Dr. Joska… $238,873
University Of Copenhagen AWD-010049: FP11701 Implement depression/adherence treatment 09/01/2024 $42,794
The General Hospital Corporation AWD-010049: FP11701 Implement depression/adherence treatment 09/01/2024 (version 0) $265,993

Quick answers

Who received award R01MH136972?

R01MH136972 was awarded to University Of Miami by National Institute of Mental Health (National Institutes of Health) on September 1, 2024.

How much is award R01MH136972 worth?

$4,410,813 has been obligated on R01MH136972.

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