Emily A Barr, Kristin Baltrusaitis, Betsy D Kennard, Graham J Emslie, Chelsea Krotje, Kevin Knowles, Sarah Buisson, Lauren Bergam, Jaime G Deville, Susan L Gillespie, Melissa Shikora, Ellen Townley, David E Shapiro, Larry K Brown
{"title":"认知行为疗法和药物管理算法与治疗艾滋病青年抑郁症的强化标准护理相比，参与者的接受度和临床医生的满意度。","authors":"Emily A Barr, Kristin Baltrusaitis, Betsy D Kennard, Graham J Emslie, Chelsea Krotje, Kevin Knowles, Sarah Buisson, Lauren Bergam, Jaime G Deville, Susan L Gillespie, Melissa Shikora, Ellen Townley, David E Shapiro, Larry K Brown","doi":"10.2989/17280583.2024.2387632","DOIUrl":null,"url":null,"abstract":"<p><p><i>Background:</i> Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians.<i>Method:</i> Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests.<i>Results:</i> Both COMB-R (<i>n</i> = 69) and ESC (<i>n</i> = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC (<i>p</i> = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R (<i>p</i> = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms (<i>p</i> = 0.52).<i>Discussion:</i> Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care.<i>Conclusion:</i> While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.</p>","PeriodicalId":45290,"journal":{"name":"Journal of Child and Adolescent Mental Health","volume":" ","pages":"1-16"},"PeriodicalIF":0.3000,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Participant acceptability and clinician satisfaction of cognitive behavioural therapy and medication management algorithm compared with enhanced standard care for treatment of depression among youth with HIV.\",\"authors\":\"Emily A Barr, Kristin Baltrusaitis, Betsy D Kennard, Graham J Emslie, Chelsea Krotje, Kevin Knowles, Sarah Buisson, Lauren Bergam, Jaime G Deville, Susan L Gillespie, Melissa Shikora, Ellen Townley, David E Shapiro, Larry K Brown\",\"doi\":\"10.2989/17280583.2024.2387632\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><i>Background:</i> Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians.<i>Method:</i> Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests.<i>Results:</i> Both COMB-R (<i>n</i> = 69) and ESC (<i>n</i> = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC (<i>p</i> = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R (<i>p</i> = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms (<i>p</i> = 0.52).<i>Discussion:</i> Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care.<i>Conclusion:</i> While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.</p>\",\"PeriodicalId\":45290,\"journal\":{\"name\":\"Journal of Child and Adolescent Mental Health\",\"volume\":\" \",\"pages\":\"1-16\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2024-11-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Child and Adolescent Mental Health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2989/17280583.2024.2387632\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Child and Adolescent Mental Health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2989/17280583.2024.2387632","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
Participant acceptability and clinician satisfaction of cognitive behavioural therapy and medication management algorithm compared with enhanced standard care for treatment of depression among youth with HIV.
Background: Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians.Method: Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests.Results: Both COMB-R (n = 69) and ESC (n = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC (p = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R (p = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms (p = 0.52).Discussion: Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care.Conclusion: While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.
期刊介绍：
The Journal of Child & Adolescent Mental Health publishes papers that contribute to improving the mental health of children and adolescents, especially those in Africa. Papers from all disciplines are welcome. It covers subjects such as epidemiology, mental health prevention and promotion, psychotherapy, pharmacotherapy, policy and risk behaviour. The journal contains review articles, original research (including brief reports), clinical papers in a "Clinical perspectives" section and book reviews. The Journal is published in association with the South African Association for Child and Adolescent Psychiatry and Allied Professions (SAACAPAP).
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