Collaborative Care for Depression in HIV Clinics

(HITIDES-H3 Trial)

Recruiting at 1 trial location

Overseen By Eva N Woodward, PhD MA BS

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

8 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of this treatment for depression in HIV clinics?

Research shows that collaborative care for depression in HIV clinics is effective and well-received by both patients and providers. Patients reported high satisfaction with the care management provided through phone calls, and providers found the documentation in electronic health records helpful, suggesting that this approach can improve depression outcomes in HIV patients. ^{1 2 3 4 5}

Is collaborative care for depression in HIV clinics safe for humans?

The research indicates that collaborative care for depression in HIV clinics is generally safe, with high patient and provider satisfaction reported. Patients found the care management through phone calls helpful, and providers appreciated the documentation and support provided by the care team. ^{1 2 3 4 5}

How does the collaborative care treatment for depression in HIV clinics differ from other treatments?

The collaborative care treatment for depression in HIV clinics is unique because it involves a team-based approach where a depression care manager coordinates care through phone calls and electronic health records, providing routine assessments and counseling. This model is tailored specifically for HIV patients, integrating mental health care into their existing treatment plans, which is different from standard depression treatments that may not be as integrated or personalized for HIV patients. ^{1 2 3 4 5}

What is the purpose of this trial?

HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) is a team-based service to manage depression in Veterans Living with HIV (VLWH). This service is more effective for managing depression than the care VLWH usually receive and saves resources. HITIDES is also liked by HIV care providers and VLWH. Despite this, no VA clinics currently offer this service. This study examines two approaches to engage clinics with HITIDES, the resulting effects on VLWH, and the costs of these approaches. The first approach includes recruiting an HIV care provider at the site to help connect with the service and a network of providers to support this person. The second approach uses an additional external expert to facilitate these connections. Understanding how to connect Veterans to the HITIDES service will allow VA to improve depression care for VLWH and save VA resources.

Research Team

Jacob T Painter, PhD PharmD

Principal Investigator

Central Arkansas Veterans Healthcare System , Little Rock, AR

Eva N Woodward, PhD MA BS

Principal Investigator

Central Arkansas Veterans Healthcare System , Little Rock, AR

Eligibility Criteria

This trial is for Veterans Living with HIV (VLWH) who are experiencing depression. Eligible VA clinics must have more than 20 VLWH, data on depression prevalence, a clinical champion to lead implementation, and willingness to participate. They should also offer diverse clinic characteristics like referral rates to mental health services.

Inclusion Criteria

Sites must allow for diversity and balance of clinic characteristics across arms (e.g. rate of referral to specialty mental health for VLWH and presence of HIV-only specialty clinic versus broad infectious disease clinic)

Sites must have an adequately sized population of Veterans Living with HIV (greater than 20)

Sites must be able to identify a clinical champion for implementation activities

Exclusion Criteria

Not applicable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation Strategy

Implementation of HITIDES intervention with a local clinical champion and learning collaborative, with or without external facilitation

18 months

Regular site visits and virtual meetings

Follow-up

Participants are monitored for changes in depression and suicidal ideation using PHQ-9 and C-SSRS

18 months

Follow-up calls and assessments

Cost and Adoption Assessment

Assessment of cost impact and adoption of intervention strategies

18 months

Treatment Details

Interventions

• External facilitation
• Implementation of Collaborative Care for Depression in VA HIV Clinics
• Learning collaborative
• Local clinical champion

Trial Overview The study tests two methods of integrating HITIDES—a service managing depression in VLWH—into VA clinics. One method involves an internal clinical champion supported by a network; the other adds an external expert facilitator. The impact on patient care and costs will be evaluated.

Participant Groups

Group I: Implementation strategy bundle 2 Experimental Treatment 3 Interventions

Local clinical champion, learning collaborative, and external facilitation.

Group II: Implementation strategy bundle 1 Experimental Treatment 2 Interventions

Local clinical champion and learning collaborative.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

The HITIDES project aimed to implement a collaborative care model for depression specifically in HIV clinics, involving a multi-site randomized trial with 249 depressed HIV patients to compare this new approach against usual care.

Qualitative evaluations and evidence-based quality improvement methods were used to adapt the intervention to the unique needs of each clinic, highlighting the importance of tailoring mental health interventions in specialty settings with high rates of depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and implementation of collaborative care for depression in HIV clinics. Curran, GM., Pyne, J., Fortney, JC., et al.[2022]

In a study of 416 HIV patients receiving collaborative care, 23.79% achieved remission from depression and 21.39% showed a response without remission after 12 months, indicating that this approach can effectively improve depression outcomes in real-world settings.

Factors such as older age were linked to higher remission rates, while psychiatric comorbidities, substance use disorders, and social isolation were associated with poorer outcomes, highlighting areas for targeted intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correlates of depression outcomes in collaborative care for HIV. Lavakumar, M., Lewis, S., Webel, A., et al.[2021]

Collaborative care for depression has proven to improve patient outcomes, but its implementation in clinics remains low; this study outlines specific steps to adapt these models to local needs while ensuring adherence to evidence-based practices.

The authors provide a detailed checklist and additional resources, such as training materials and decision support systems, to assist clinicians and administrators in effectively implementing collaborative care models for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Steps for implementing collaborative care programs for depression. Fortney, JC., Pyne, JM., Smith, JL., et al.[2019]

The collaborative care model for depression in HIV care settings was well-received by patients, who found the support and routine screening beneficial for managing their depressive symptoms.

Using the Patient Health Questionnaire-9 not only helped providers assess patients' depression but also empowered patients to self-manage their symptoms, indicating its potential as a valuable self-management tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The collaborative care model for HIV and depression: Patient perspectives and experiences from a safety-net clinic in the United States. Fuller, SM., Koester, KA., Erguera, XA., et al.[2022]

The study found that a centralized offsite depression care team, including a psychiatrist and a depression care manager, effectively provided care to HIV patients, leading to high satisfaction among both patients and providers.

Implementing routine depression screening during patient intake processes improved screening rates, highlighting the importance of integrating mental health care into standard HIV treatment protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

HIV patient and provider feedback on a telehealth collaborative care for depression intervention. Drummond, KL., Painter, JT., Curran, GM., et al.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

Development and implementation of collaborative care for depression in HIV clinics. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Correlates of depression outcomes in collaborative care for HIV. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Steps for implementing collaborative care programs for depression. [2019]

4. England pubmed.ncbi.nlm.nih.gov

The collaborative care model for HIV and depression: Patient perspectives and experiences from a safety-net clinic in the United States. [2022]

5. England pubmed.ncbi.nlm.nih.gov

HIV patient and provider feedback on a telehealth collaborative care for depression intervention. [2019]