A Preliminary RCT of CBT-AD for Adherence and Depression Among HIV-Positive Latinos on the U.S.-Mexico Border: The Nuevo Día Study

Abstract

We conducted a preliminary RCT among 40 HIV-positive Latinos of Mexican descent on the U.S.-Mexico border who indicated imperfect adherence and depressive symptomatology. Participants were randomly assigned to culturally adapted cognitive-behavioral therapy for adherence and depression (CBT-AD) with an alarmed pillbox or usual care. Outcomes were depressive symptoms (self-report and blind clinician ratings), adherence (self-report and electronic pillbox), and biological markers. The intervention, delivered in English and Spanish, proved feasible and acceptable. Generalized estimating equations in intent-to-treat analyses showed some effects of “moderate” to “large” size, with maintenance over time. For example, intervention (vs. control) participants demonstrated at post-intervention a greater drop in BDI scores (OR = - 3.64, p = .05) and greater adherence according to the electronic pillbox (OR = 3.78, p = .03). Biological markers indicated some relative improvement for CD4 count but not VL. The promising results suggest a larger trial to determine efficacy is warranted.

Cognitive behavioral therapy improves adherence to antiretroviral therapy in HIV-infected patients: a prospective randomized controlled trial from eastern India

“…The beneficial effect of CBT observed in our study actually reflected the outcome of various international studies undertaken so far [28,29,[31][32][33]. But CD4 count did not show any significant difference between 2 groups after CBT sessions as opposed to the finding in some of the recent studies [32,33]. When we looked at various factors responsible for non-adherence to ART, polarized thinking (27%), mind reading (27%) and magnification (20%) were found to be the major ones and in fact, some of the patients were having more than one factor together.…”

“…The study showed a significantly better mean adherence level and Beck's depression score in patients of the intervention group. The beneficial effect of CBT observed in our study actually reflected the outcome of various international studies undertaken so far [28,29,[31][32][33]. But CD4 count did not show any significant difference between 2 groups after CBT sessions as opposed to the finding in some of the recent studies [32,33].…”

Optimizing ART Adherence: Update for HIV Treatment and Prevention

“…The interventions reviewed ranged from individual counseling to text messaging to computerized self-administered approaches among various populations, such as youth [32, 33], newly released inmates [34], transgender women [35], and adults with low health literacy [36]. Among those interventions for adults, some had samples that were predominantly African American [32], except for two that were specifically developed for Hispanic and Latino individuals [37, 38]. Among those integrating technological components, one intervention used a self-administered computer program [39], three used text messages [40–42], one was a self-administered ART adherence breathalyzer [43], and another a mobile application [44] for use with smartphones.…”

Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy

“…Although our findings may be generalisable to other strong ART programmes with high adherence levels, in some settings adherence is most likely an important mediator between depression and attrition, and adherence-related support may represent an important intervention. Results from a small randomised study conducted in Mexico raise the possibility that treatment of depression may be a requirement for a sizeable and sustained improvement in adherence for HIV-infected adults with depression 40. Further study of the biological mechanisms responsible for the relationship between depression and adverse ART outcomes will inform the management of patients with these two conditions.…”