The sister cities of El Paso, Texas and Ciudad Juarez, Chihuahua situated on the U.S.-Mexico border face a potential explosion in the HIV epidemic. Although antiretroviral therapy (ART) is increasingly available and accessible, preliminary studies indicate that poor adherence and depressive symptomatology detract from its potential success. There no reports in the literature of empirically supported treatments that specifically target this populations. This application, prepared in response to PAR-07-341: HIV Treatment Adherence Research, proposes a 3-year R34 to adapt culturally and then pilot test an empirically supported cognitive-behavioral therapy program for adherence and symptoms of depression (CBT-AD). Additionally, we will assess the feasibility and efficacy of a novel medication monitoring and reminder system (MedSignals(r)) in the form of an electronic pillbox with monitoring and reminding functions that is available in a Spanish-language version. Preliminary work has demonstrated the need for this type of support and the intervention's effectiveness in a different population. In line with the principles of community-based participatory research, researchers at the University of Washington have partnered with a local AIDS service organization (La Fe) as well as faculty at the University of Texas at El Paso to develop the research and mental health infrastructure in the region and design a sustainable treatment program.
Specific aims of the study include, first, conducting formative research to adapt the CBT-AD intervention. This qualitative phase of the project will involve the institution of a community advisory board, focus groups, and key informant interviews, and will adhere to the CDC's Map of Adaptation Process.
The second aim i s to conduct a 2x2 randomized controlled pilot trial among 60 HIV+ Latino adults with depressive symptomatology and suboptimal adherence, comparing the CBT-AD and/or the electronic pillbox to treatment as usual. Our hypotheses are grounded in a conceptual model proposing that the CBT-AD will improve problem solving ability and decrease depressive symptomatology, which will directly improve biomedical outcomes of HIV-1 RNA viral load and CD4 as well as indirectly improve biomedical outcomes through increased motivation, improved memory, and better medication adherence. The electronic pillbox is hypothesized to directly improve on-time adherence after increasing the salience of environmental cues. The innovation and significance of the project lie in the evaluation of a novel technology and the development of a theoretically grounded mental health and adherence treatment specifically geared toward low-income Latinos. Evaluating and implementing generalizable and sustainable mental health and adherence interventions such as the ones proposed are urgently needed in the region to improve HIV treatment outcomes and thwart the development and transmission of drug resistant virus.
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