Skip to main content

Advertisement

Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

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 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 = 0.05) and greater adherence according to the electronic pillbox (OR = 3.78, p = 0.03). Biological markers indicated some relative improvement for CD4 count but not VL. The promising results suggest a larger trial to determine efficacy is warranted.

Resumen

Llevamos a cabo un estudio preliminar, aleatorizado y controlado (RCT por sus siglas en inglés) en la región fronteriza de Estados Unidos y México con 40 Latinos, VIH seropositivos, de descendencia Mexicana quienes reportaron adherencia imperfecta y sintomatología depresiva. Participantes fueron asignados aleatoriamente a una terapia cognitiva conductual (la cual fue culturalmente adaptada) para adherencia y depresión (CBT-AD por sus siglas en inglés) con uso de una caja de medicamentos equipada con alarma o a recibir el tratamiento estándar. Los variables de resultados fueron síntomas depresivos (autoinforme y evaluación clínica hecho a ciegas), adherencia (autoinforme y caja electrónica), y marcadores biológicos. La intervención, proveída en inglés y en español, demostró ser factible y aceptable. Análisis de las ecuaciones de estimación generalizada (GEE) y de intención de proveer el tratamiento demostraron efectos de tamaño “moderado” a “grande”, y también indicaron algo de mantenimiento tras el tiempo. Por ejemplo, en la etapa después que se terminó el tratamiento, los participantes en el grupo CBT-AD demostraron una reducción mas grande en puntuación de síntomas depresivos [(BDI) OR = 3.64, p = 0.05] y un mejoramiento en adherencia según los datos de la caja electrónica. Los marcadores biológicos mostraron algún mejoramiento en el nivel de las células CD4 pero no en la carga viral. Estos resultados son positivos y sugieren que un estudio más extenso sería justificado.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. CDC. HIV Surveillance Report, 2009. http://www.cdc.gov/hiv/topics/surveillance/resource/reports/ (2009). Accessed 29 Sep 2011.

  2. del Rio C. Latinos and HIV care in the southeastern United States: new challenges complicating longstanding problems. Clin Infect Dis. 2011;53(5):488–9.

    Article  PubMed  Google Scholar 

  3. Sanchez MA, Lemp GF, Magis-Rodríguez C, Bravo-García E, Carter S, Ruiz JD. The epidemiology of HIV among Mexican migrants and recent immigrants in California and Mexico. J Acquir Immune Defic Syndr. 2004;37(Suppl 4):S204–14.

    Article  PubMed  Google Scholar 

  4. Santos G, Puga AM, Medina C. HAART, adherence, and cultural issues in the US Latino community. AIDS Read. 2004;14(Suppl 10):S26–9.

    PubMed  Google Scholar 

  5. Murphy DA, Roberts KJ, Hoffman D, Molina A, Lu MC. Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients. AIDS Care. 2003;15(2):217–30.

    Article  PubMed  CAS  Google Scholar 

  6. Simoni JM, Amico KR, Pearson CR, Malow R. Strategies for promoting adherence to antiretroviral therapy: a review of the literature. Curr Infect Dis Rep. 2008;10(6):515–21.

    Article  PubMed  Google Scholar 

  7. Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: translating research findings to the real world clinic. Curr HIV/AIDS Rep. 2010;7(1):44–51.

    Article  PubMed  Google Scholar 

  8. Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S23–35.

    Article  PubMed  Google Scholar 

  9. van Servellen G, Nyamathi A, Carpio F, et al. Effects of a treatment adherence enhancement program on health literacy, patient-provider relationships, and adherence to HAART among low-income HIV-positive Spanish-speaking Latinos. AIDS Patient Care STDS. 2005;19(11):745–59.

    Article  PubMed  Google Scholar 

  10. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.

    Article  PubMed  CAS  Google Scholar 

  11. Safren SA, Otto MW, Worth JL, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–62.

    Article  PubMed  CAS  Google Scholar 

  12. Longoria V, Wiebe JS, Jones A. A nurse-based disease management model of HIV/AIDS care on the U.S./Mexico Border. In: Curiel H, editor. Innovative strategies for HIV/AIDS prevention & care along the U.S./Mexico Border. Washington: HRSA; 2007.

    Google Scholar 

  13. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.

    PubMed  Google Scholar 

  14. Sherr L, Clucas C, Harding R, Sibley E, Catalan J. HIV and depression—a systematic review of interventions. Psychol Health Med. 2011;16(5):493–527.

    Article  PubMed  Google Scholar 

  15. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review [published online ahead of print May 30 2012]. AIDS Behav. 2012;16:2119–43. http://www.springerlink.com/content/q00283l02312tjw7/. Accessed 28 June 2012.

  16. Wagner GJ, Goggin K, Remien RH, et al. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011;42(3):352–60.

    Article  PubMed  Google Scholar 

  17. Safren SA, Radomsky AS, Otto MW, Salomon E. Predictors of psychological well-being in a diverse sample of HIV-positive patients receiving highly active antiretroviral therapy. Psychosomatics. 2002;43(6):478–85.

    Article  PubMed  Google Scholar 

  18. Kelly JA, Murphy DA, Bahr GR, et al. Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. Am J Psychiatry. 1993;150(11):1679–86.

    PubMed  CAS  Google Scholar 

  19. Mulder CL, Emmelkamp PM, Antoni MH, Mulder JW, Sandfort TG, de Vries MJ. Cognitive-behavioral and experiential group psychotherapy for HIV-infected homosexual men: a comparative study. Psychosom Med. 1994;56(5):423–31.

    PubMed  CAS  Google Scholar 

  20. Thomason BT, Bachanas PJ, Campos PE. Cognitive behavioral interventions with persons affected by HIV/AIDS. Cogn Behav Pract. 1996;3:417–42.

    Article  Google Scholar 

  21. Balfour L, Kowal J, Silverman A, et al. A randomized controlled psycho-education intervention trial: improving psychological readiness for successful HIV medication adherence and reducing depression before initiating HAART. AIDS Care. 2006;18(7):830–8.

    Article  PubMed  CAS  Google Scholar 

  22. Laperriere A, Ironson GH, Antoni MH, et al. Decreased depression up to one year following CBSM+ intervention in depressed women with AIDS: the smart/EST women’s project. J Health Psychol. 2005;10(2):223–31.

    Article  PubMed  Google Scholar 

  23. Olatunji BO, Mimiaga MJ, O’Cleirigh C, Safren SA. Review of treatment studies of depression in HIV. Top HIV Med. 2006;14(3):112–24.

    PubMed  Google Scholar 

  24. Yun LWH, Maravi M, Kobayashi JS, Barton PL, Davidson AJ. Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. J Acquir Immune Defic Syndr. 2005;38(4):432–8.

    Article  PubMed  CAS  Google Scholar 

  25. Safren SA, Gonzalez JS, Soroudi N. Coping with chronic illness: cognitive behavioral therapy for adherence and depression in individuals with chronic illness, client workbook. New York: Oxford University Press; 2007.

    Google Scholar 

  26. Safren SA, Gonzalez JS, Soroudi N. Coping with chronic illness: cognitive behavioral therapy for adherence and depression in individuals with chronic illness, therapist guide. New York: Oxford University Press; 2007.

    Google Scholar 

  27. Nezu AM, Nezu CM, Friedman SH, Faddis S, Houts PS. Helping cancer patients cope: a problem-solving approach. Washington: American Psychological Association; 1998.

    Book  Google Scholar 

  28. Nezu A, Nezu C, Friedman SH, Houts P, Faddis S. Project Genesis: application of problem-solving therapy to individuals with cancer. Behav Ther. 1997;9:155–8.

    Google Scholar 

  29. Safren S, Otto M, Worth J. Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cogn Behav Pract. 1999;6(4):332–41.

    Article  Google Scholar 

  30. Safren SA, O’Cleirigh C, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28(1):1–10.

    Article  PubMed  Google Scholar 

  31. Brigido LF, Rodrigues R, Casseb J, et al. Impact of adherence to antiretroviral therapy in HIV-1-infected patients at a university public service in Brazil. AIDS Patient Care STDS. 2001;15(11):587–93.

    Article  PubMed  CAS  Google Scholar 

  32. Mills EJ, Nachega JB, Bangsberg DR, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3(11):e438.

    Article  PubMed  Google Scholar 

  33. Weiser S, Wolfe W, Bangsberg D, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34(3):281–8.

    Article  PubMed  Google Scholar 

  34. Zogg JB, Woods SP, Sauceda JA, Wiebe JS, Simoni JM. The role of prospective memory in medication adherence: a review of an emerging literature. J Behav Med. 2011;35(1):47–62.

    Article  PubMed  Google Scholar 

  35. Andrade ASA, McGruder HF, Wu AW, et al. A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment. Clin Infect Dis. 2005;41(6):875–82.

    Article  PubMed  Google Scholar 

  36. Safren SA, Hendriksen ES, Desousa N, Boswell SL, Mayer KH. Use of an on-line pager system to increase adherence to antiretroviral medications. AIDS Care. 2003;15(6):787–93.

    Article  PubMed  CAS  Google Scholar 

  37. Simoni JM, Huh D, Frick PA, et al. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial. J Acquir Immune Defic Syndr. 2009;52(4):465–73.

    Article  PubMed  Google Scholar 

  38. McKleroy VS, Galbraith JS, Cummings B, et al. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Educ Prev. 2006;18(4 Suppl A):59–73.

    Article  PubMed  Google Scholar 

  39. Nezu AM, Nezu CM, Felgoise SH, McClure KS, Houts PS. Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol. 2003;71(6):1036–48.

    Article  PubMed  Google Scholar 

  40. Organista K. Cognitive-behavioral therapy with Latinos and Latinas. In: Hays PA, Iwamasa GY, editors. Culturally responsive cognitive-behavior therapy: assessment, practice, and supervision. Washington: American Psychological Association; 2006. p. 73–96.

    Chapter  Google Scholar 

  41. Bedoya CA, Safren SA. Capturing (and communicating) complexity: adapting CBT for clients with multiple diversity [commentary on the case of Felix: an example of gay-affirmative cognitive-behavioral therapy]. Pragmat Case Stud Psychother. 2009;5(2):22–7.

    Google Scholar 

  42. Trinh NT, Bedoya CA, Chang TE, Flaherty K, Fava M, Yeung A. A study of a culturally focused psychiatric consultation service for Asian American and Latino American primary care patients with depression. BMC Psychiatry. 2011;11(1):166.

    Article  PubMed  Google Scholar 

  43. Brislin RW. Translation and content analysis of oral and written material. In: Triandis HC, Berry JW, editors. Handbook of cross-cultural psychology. Boston: Allyn & Bacon; 1980. p. 389–444.

    Google Scholar 

  44. Amico KR, Fisher WA, Cornman DH, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42(4):455–9.

    Article  PubMed  Google Scholar 

  45. Beck AT, Steer RA. Manual for the Beck Depression Inventory. San Antonio: Psychological Corporation; 1993.

    Google Scholar 

  46. Bonicatto S, Dew AM, Soria JJ. Analysis of the psychometric properties of the Spanish version of the Beck Depression Inventory in Argentina. Psychiatry Res. 1998;79(3):277–85.

    Article  PubMed  CAS  Google Scholar 

  47. Sanz J, Vázquez C. Fiabilidad, validez, y datos normativos del inventario para la depresión de Beck [Reliability, validity, and normative data from the Beck Depression Inventory]. Psicothema. 1998;10:303–18.

    Google Scholar 

  48. Suárez-Mendoza AA, Cardiel MH, Caballero-Uribe CV, Ortega-Soto HA, Márquez-Marín M. Measurement of depression in Mexican patients with rheumatoid arthritis: validity of the Beck Depression Inventory. Arthritis Care Res. 1997;10(3):194–9.

    Article  PubMed  Google Scholar 

  49. Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis. 2000;188(10):662–70.

    Article  PubMed  CAS  Google Scholar 

  50. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–9.

    Article  PubMed  CAS  Google Scholar 

  51. Lobo A, Chamorro L, Luque A, et al. Validation of the Spanish versions of the Montgomery–Asberg depression and Hamilton anxiety rating scales. Med Clin (Barc). 2002;118(13):493–9.

    Article  PubMed  Google Scholar 

  52. Kørner A, Nielsen BM, Eschen F, et al. Quantifying depressive symptomatology: inter-rater reliability and inter-item correlations. J Affect Disord. 1990;20(2):143–9.

    Article  PubMed  Google Scholar 

  53. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.

    Article  Google Scholar 

  54. Huh D, Flaherty BP, Simoni JM. Optimizing the analysis of adherence interventions using logistic generalized estimating equations. AIDS Behav. 2011;16(2):422–31.

    Article  Google Scholar 

  55. Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr. 2006;41(3):285–97.

    Article  PubMed  Google Scholar 

  56. Sikkema KJ, Watt MH, Drabkin AS, Meade CS, Hansen NB, Pence BW. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010;14(2):252–62.

    Article  PubMed  Google Scholar 

  57. Health Professional Shortage Areas (HRSA). Health Professional Shortage Area NHSC Fulfillment of Mental Health Care HPSA Needs Summary. http://datawarehouse.hrsa.gov/hpsadetail.aspx (2005). Accessed 1 Sep 2007.

  58. Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect Psychol Sci. 2011;6(1):21–37.

    Article  Google Scholar 

  59. Altman DG, Bland JM. How to randomize. BMJ. 1999;319(7211):703–4.

    Article  PubMed  CAS  Google Scholar 

  60. Robbins RN, D’Aquila E, Morgello S, Byrd D, Remien RH, Mindt MR. Cultural influences on antiretroviral therapy adherence among HIV-infected Puerto Ricans. J Assoc Nurses AIDS Care. 2012;23(6):531–8.

    Article  PubMed  Google Scholar 

  61. De Las Nueces D, Hacker K, DiGirolamo A, Hicks LS. A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups. Health Serv Res. 2012;47(2):1363–86.

    Article  Google Scholar 

  62. Becker MA, Martinez-Tyson D, DiGennaro J, Ochshorn E. Do Latino and non-Latino White Medicaid-enrolled adults differ in utilization of evidence-based treatment for major depressive disorder? J Immigr Minor Health. 2011;13(6):1048–54.

    Article  PubMed  Google Scholar 

  63. Keyes KM, Martins SS, Hatzenbuehler ML, Blanco C, Bates LM, Hasin DS. Mental health service utilization for psychiatric disorders among Latinos living in the United States: the role of ethnic subgroup, ethnic identity, and language/social preferences. Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):383–94.

    Article  PubMed  CAS  Google Scholar 

  64. Soller M, Kharrazi N, Prentiss D, et al. Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity. AIDS Care. 2011;23(11):1351–9.

    Article  PubMed  Google Scholar 

  65. Brown SD, Lee K, Schoffman DE, King AC, Crawley LM, Kiernand M. Minority recruitment into clinical trials: experimental findings and practical implications. Contemp Clin Trials. 2012;33(4):620–3.

    Article  PubMed  Google Scholar 

  66. Rivera-Goba MV, Dominguez DC, Stoll P, Grady C, Ramos C, Mican JM. Exploring decision-making of HIV-infected Hispanics and African Americans participating in clinical trials. J Assoc Nurses AIDS Care. 2011;22(4):295–306.

    Article  PubMed  Google Scholar 

  67. Gonzalez JS, Hendriksen ES, Collins EM, Durán RE, Safren SA. Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS Behav. 2008;13(3):582–602.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to the patients and staff of Centro de Salud Familiar la Fe CARE Center, Inc. for their participation and facilitation of this study. We thank members of our community and administrative advisory boards as well as research consultants Jaime Anaya, Kurt C. Organista, Steffanie A. Strathdee, Karina Walters, and Randolph Whitworth. We would also like to thank those who aided with project implementation, including Jessica Armendariz, Teresa Frias, Carolina Lara, Chrisie Lemon, Virginia Longoria, Elsa Martin, Antonio Martinez, Miriam Pando, Tatiana Rodriguez, and Cesar Villareal Ramos from the University of Texas at El Paso, and Kimberly Nelson, Cynthia Pearson, and Samantha Yard from the University of Washington. This research project was supported by the National Institute of Mental Health (Grant # 1R34MH08674 and minority research supplement award # R34MH084674-S1) and in part by the Center for AIDS Research (Grant # P30 AI027757).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jane M. Simoni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simoni, J.M., Wiebe, J.S., Sauceda, J.A. et al. A Preliminary RCT of CBT-AD for Adherence and Depression Among HIV-Positive Latinos on the U.S.-Mexico Border: The Nuevo Día Study. AIDS Behav 17, 2816–2829 (2013). https://doi.org/10.1007/s10461-013-0538-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0538-5

Keywords

Navigation