Participant Acceptability and Clinician Satisfaction of Cognitive Behavioral Therapy and a Medication Management Algorithm Compared with Enhanced Standard Care for Treatment of Depression among Youth Living with HIV

Title

Presenter

Lauren Bergam

Authors

L. Bergam * (1), K. Baltrusaitis (2), B. Kennard (3), G. Emslie (4), C. Krotje (5), K. Knowles (5), S. Buisson (6), J. Deville (7), E. Barr (8), S. Gillespie (9), M. Shikora (10), L. Levy (6), E. Townley (11), D. Shapiro (2), L. Brown (12)

Institutions

(1) Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, United States, (2) Harvard University T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, United States, (3) University of Texas Southwestern Medical Center, Dallas, United States, (4) University of Texas Southwestern, Medical Center, Dallas, United States, (5) Frontier Science Foundation, Amherst, United States, (6) FHI 360, Durham, United States, (7) David Geffen School of Medicine at the University of California, Los Angeles, United States, (8) University of Colorado School of Medicine Children''s Hospital, Aurora, United States, (9) Texas Children''s Hospital/Baylor College of Medicine, Houston, United States, (10) SUNY Stony Brook NICHD, Stony Brook, United States, (11) National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, United States, (12) Rhode Island Hospital, Alpert Medical School of Brown University, Providence, United States

BACKGROUND: Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that a Cognitive Behavioral Therapy (CBT) and Medication Management Algorithm (MMA) (COMB-R) significantly improved depression outcomes in Youth Living with HIV (YLWH) compared with Enhanced Standard Care (ESC). Because participant perspectives and experiences of CBT are an important complement to treatment efficacy (Olsson, JBCT, 2021), we examined and compared the acceptability and satisfaction of these approaches among study participants and clinicians.
METHODS: Between March 2017 and March 2019, 13 U.S. sites enrolled YLWH, ages 12-24, diagnosed with nonpsychotic depression. Using restricted randomization to balance site characteristics, sites were randomized to either COMB-R (CBT administered by a therapist and a licensed prescriber trained in the MMA) or ESC (standard psychotherapy and medication management). After intervention conclusion at Week 24, participants and clinicians (licensed prescribers and therapists) rated their acceptability and satisfaction of the treatment in multi-question surveys, with higher ratings indicating more desirable outcomes. Site-level means were compared using Wilcoxon tests.
RESULTS: Overall, 69 participants were in COMB-R and 71 were in ESC. The mean age was 21.4 years, 53% were female, and 54% were living with perinatally acquired HIV. Baseline age, sex, depression levels, RNA viral load, and CD4 count were similar between groups. The distribution of site-level mean participant acceptability (quality, expectations, and overall satisfaction with treatment) was greater in COMB-R compared with ESC (Table 1). The distribution of site-level mean licensed prescriber satisfaction (ease of using the intervention and improvement of participants' symptoms) was also greater in COMB-R compared with ESC. The distribution of site-level mean therapist satisfaction did not differ between groups.

Table 1. Median (Minimum, Maximum) of site-level mean participant acceptability and clinician satisfaction
Survey Survey Description COMB-R
(6 sites) ESC
(7 sites) P-value
(Wilcoxon Test)
Participant acceptability 8 questions; scale from 1 to 4
3.7 (3.5, 3.9)
3.4 (3.3, 3.7)
0.04
Prescribing clinician satisfaction 2 questions; scale from 0 to 4
3.2 (2.5, 3.4)
2.4 (2.0, 3.0)
0.01
Counseling clinician satisfaction 6 questions; scale from 0 to 3
2.1 (1.9, 2.8)
2.3 (2.0, 2.6)
0.52

CONCLUSIONS: We found that mean acceptability and satisfaction for participants and licensed prescribers were significantly higher at COMB-R sites compared with ESC sites. These results further support the use of CBT and MMA in treating depression among YLWH.

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Survey	Survey Description	COMB-R (6 sites)	ESC (7 sites)	P-value (Wilcoxon Test)
Participant acceptability	8 questions; scale from 1 to 4	3.7 (3.5, 3.9)	3.4 (3.3, 3.7)	0.04
Prescribing clinician satisfaction	2 questions; scale from 0 to 4	3.2 (2.5, 3.4)	2.4 (2.0, 3.0)	0.01
Counseling clinician satisfaction	6 questions; scale from 0 to 3	2.1 (1.9, 2.8)	2.3 (2.0, 2.6)	0.52