Implementation of a Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression of People Living with HIV in Korea

Abstract

Background Cognitive behavioral therapy for adherence and depression (CBT-AD) performed by clinical psychologists is an effective treatment for improving the depression in people living with HIV (PLWH). However, because access to clinical psychologists is limited in most clinics, CBT-AD is rarely performed for PLWH in Korea. This pilot study evaluates whether CBT-AD can be effectively performed by a nurse trained and supervised by a clinical psychologist, with a view to the wider provision of CBT-AD. Materials and Methods One clinical psychologist developed manuals, educated and supervised one nurse. PLWH with depression or adherence to self-reported antiretroviral therapy <90% were enrolled, and CBT-AD was conducted once weekly for 12 sessions. PLWH were assessed for adherence by visual analog scale, Beck depression inventory (BDI) for depression, PozQoL for quality of life, and Berger’s 40-item stigma scale for stigma at baseline, after the 6th, 12th session, at 4-, and 8-months after CBT-AD. Acceptability for PLWH and feasibility for providers were evaluated through surveys. Results Five male PLWH have completed the study protocols (mean age 29.2 years). All study participants showed improving depression (mean BDI at baseline 33.0 ± 7.0, and after the 12th session 13.4 ± 3.5), and the effect was maintained at the 8-month follow-up (BDI 15.4 ± 6.4). Quality of life showed a tendency to improve (mean PozQoL at baseline 28.0 ± 7.7, after 12th session 36.8 ± 4.4, and at the 8-month follow-up 38.2 ± 7.9), but stigma did not show clear improvement (Berger’s 40-item stigma scale at baseline 121.0 ± 3.9, after 12th session 107.6 ± 8.8. and at the 8-month follow-up 107.6 ± 5.0). All study participants received great help from CBT-AD and expressed their desire to continue. All providers agreed that nurse-delivered CBT-AD could be implemented in routine clinical practice. Conclusion Our findings suggest that a nurse-delivered CBT-AD could be feasible and acceptable for PLWH through structured interventions. It has been shown to have the potential to help PLWH, especially for their depression and quality of life. Trial Registration ClinicalTrials.gov Identifier: NCT03823261

“I want to be healthy and move on”: A qualitative study of barriers and facilitators to antiretroviral treatment adherence among young adult survivors with perinatal HIV in Thailand

“…Cultural appropriate intervention to reduce stigma in the community that involves people living with HIV in designing and implementation is also required [ 32 ]. Stigma-reduction interventions for YPHIV might include cognitive behavioral therapy to boost self-esteem and improve stress management, which was reported from studies in low-middle-income countries as an effective approach [ 33 , 34 ].…”

The Story and Implications of the Korean Health Care Facility Counseling Project on People Living with HIV

“…The second common goal was to identify the level of depression and anxiety among PLWH throughout their diagnosis and treatment journey, and manage and relieve them, while referring them to relevant services to induce emotional stability. Their psychological and emotional aspects, such as diminished self-esteem, fear of others’ judgment, guilt, fear of death, and hopelessness, were addressed during counseling to reduce suicidal ideation and prevent poor medication adherence induced by psychological anxiety, thereby contributing to improved quality of life [ 12 ].…”

HIV Service Delivery Innovations in the Philippines during the COVID-19 Pandemic

“…In a recent article in Infect Chemother, Kim et al [ 1 ] shared their innovations in human immunodeficiency virus (HIV) services that can be implemented in localities with scarce health resources. In addition to rural areas, nurse-led therapy can be useful in low- and middle-income countries (LAMICs) in their goal of ending their HIV epidemic.…”