Approximately 37-50% of HIV positive individuals suffer from depression, which is associated with substance use, poor adherence to HIV medication, an increase in HIV risk behaviors, and subsequent poor health outcomes (e.g., Asch et al., 2003;Bing et al., 2001;Dew et al., 1997;Johnson, Rabkin, Lipsitz, Williams, &Remien, 1999). Additionally, depressed HIV positive substance users are at an even greater risk for poor medication adherence than non-substance users (Cook, Grey, &Burke-Miller, 2004). Notably, evidence indicates that HIV positive patients who receive treatment for depression exhibit significant improvements in HIV medication adherence and a reduction in risk behaviors that are directly relevant to their health and well being such as risky sexual behavior (e.g., Cook et al., 2006). Despite this link, few interventions targeting depression have been developed to meet the specific needs of HIV-infected substance users. This is especially evident for low income African American HIV positive substance users who often do not receive adequate treatment for any of these conditions due to poverty, lack of access to specialized treatment, low motivation, cognitive impairments, and a lack of coordination between medical, mental health, and substance abuse treatment providers (Calsyn et al., 2004). Thus, the objective of the present proposal is to test a novel, behavioral approach to treat depressive symptoms and improve HIV medication adherence and subsequent physical health outcomes among 170 African American HIV infected substance users residing in inner-city Washington, DC. This treatment combines (1) LET'S ACT, a behavioral activation based treatment for depressed substance users (Daughters, Braun, Sargeant, Hopko, Blanco, &Lejuez, in press), with (2) Life Steps, an HIV medication adherence intervention (Safren, Otto, &Worth, 1999). The purpose of this combined treatment (i.e., ACT HEALTHY;see Appendix for the preliminary therapist and patient manuals), will be to compliment standard residential and follow-up outpatient substance use treatment to specifically treat depressive symptoms with the additional goal of improving HIV medication adherence, substance use, and physical health outcomes. One hundred and seventy HIV positive minority substance users with elevated depressive symptoms will be randomly assigned to either treatment as usual (TAU) plus ACT HEALTHY or TAU plus Nondirective Therapy to test the efficacy of ACT HEALTHY. Treatment as usual for both groups consists of standard residential and outpatient substance abuse treatment. Based on the outcome of this preliminary trial, the ACT HEALTHY protocol will be further refined and readied for larger-scale clinical trials.

Public Health Relevance

The objective of the present proposal is to test a novel, behavioral approach to treat depressive symptoms and improve HIV medication adherence and subsequent physical health outcomes among African American HIV infected substance users residing in inner-city Washington, DC. This treatment will serve as a compliment to standard residential and follow-up outpatient substance use treatment, with the goal of reducing depressive symptoms and improving HIV medication adherence, physical health, and substance use outcomes. From a longer term perspective, this grant will set the stage for more large-scale testing to determine its utility as a specialized, efficacious treatment for a significant subpopulation at greatest risk for difficulties with depressive symptoms, HIV medication adherence, and relapse to substance use, and will therefore have important clinical and public health significance in reducing HIV transmission.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA022974-02S1
Application #
7867555
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Kahana, Shoshana Y
Project Start
2008-09-01
Project End
2012-06-30
Budget Start
2009-07-01
Budget End
2010-06-30
Support Year
2
Fiscal Year
2009
Total Cost
$42,000
Indirect Cost
Name
University of Maryland College Park
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
790934285
City
College Park
State
MD
Country
United States
Zip Code
20742
Magidson, Jessica F; Listhaus, Alyson; Seitz-Brown, C J et al. (2015) Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users? J Behav Med 38:337-47
Magidson, Jessica F; Seitz-Brown, C J; Safren, Steven A et al. (2014) Implementing Behavioral Activation and Life-Steps for Depression and HIV Medication Adherence in a Community Health Center. Cogn Behav Pract 21:386-403
Magidson, Jessica F; Seitz-Brown, C J; Listhaus, Alyson et al. (2013) Distress tolerance and use of antiretroviral therapy among HIV-infected individuals in substance abuse treatment. AIDS Patient Care STDS 27:518-23
Banducci, Anne N; Dahne, Jennifer; Magidson, Jessica F et al. (2013) Clinical characteristics as a function of referral status among substance users in residential treatment. Addict Behav 38:1924-30
Lechner, William V; Dahne, Jennifer; Chen, Kevin W et al. (2013) The prevalence of substance use disorders and psychiatric disorders as a function of psychotic symptoms. Drug Alcohol Depend 131:78-84
Magidson, Jessica F; Listhaus, Alyson R; Seitz-Brown, C J et al. (2013) Rumination Mediates the Relationship Between Distress Tolerance and Depressive Symptoms Among Substance Users. Cognit Ther Res 37:456-465
Yi, Richard; Carter, Anne E; Landes, Reid D (2012) Restricted psychological horizon in active methamphetamine users: future, past, probability, and social discounting. Behav Pharmacol 23:358-66
McHugh, R Kathryn; Daughters, Stacey B; Lejuez, Carl W et al. (2011) Shared Variance among Self-Report and Behavioral Measures of Distress Intolerance. Cognit Ther Res 35:266-275
Daughters, Stacey B; Magidson, Jessica F; Schuster, Randi M et al. (2010) ACT HEALTHY: A Combined Cognitive-Behavioral Depression and Medication Adherence Treatment for HIV-Infected Substance Users. Cogn Behav Pract 17:309-321