Behavioural therapy model shown to successfully treat HIV/AIDS and depression
A new study by researchers at the University of Miami has the potential for treating people struggling with HIV/AIDS and depression. The study was based in South Africa, home to the highest number of cases in the world and a significant shortage of mental health professionals – it demonstrated the effectiveness of training nurses in public HIV clinics to deliver a specially adapted cognitive behaviour therapy (CBT) to help people with depression and uncontrolled HIV adhere to their prescribed medication regiment.
CBT is a proven approach for changing faulty or unhelpful thinking or behavioural patterns.
In the study, led by the University of Miami’s Steven Safren, researchers recruited 161 patients with uncontrolled HIV/AIDS and clinical depression from four public health clinics in the township of Khayelitsha, just outside Cape Town. The clinics have limited psychological services but could prescribe out antidepressants to patients.
At the onset of the study, all participants received the usual enhanced care for clinically depressed HIV-AIDS patients who did not achieve viral suppression after receiving the first month of their antiretroviral medication. That customary treatment included another prescription and follow-up meetings with an adherence counsellor.
Half the patients were also randomly assigned to attend eight cognitive-behavioural therapy for adherence and depression (CBT-AD) sessions. The sessions consisted of adherence counselling which included modules on life skills, depression, relaxation, mood monitoring, and problem-solving.
According to Safren, professor of psychology and director of the University’s Center for HIV/AIDS Research and Mental Health, the CBT-AD interventions were designed to help patients “turn down the volume” of their mental health symptoms, so they would be more open to counseling on the benefit of taking their medication. To track their adherence, the patients also received an electronic pill box that, every time it was opened, transmitted a real-time signal to a web server.
Researchers later found patients who completed the CBT-AD sessions were more than 2.5 times more likely to achieve undetectable viral loads that those who underwent the usual care.
The next step will be for the research team to evaluate how to sustainably implement the CBT-AD approach in South Africa. Safren said the task-shared approach could be viable in Miami, where there are fewer services to help people achieve viral suppression than in other US cities with large populations of people living with the virus.
“South Africa has the most cases of HIV/AIDS in the world and Miami is the city with the highest incidence of new cases in the U.S. — so there is a parallel,” Safren pointed out. “And unlike places like New York or Massachusetts, where people are more likely to be virally suppressed, Florida [unfortunately] doesn’t have the same public health resources.”
