Comparative Trial of Antidepressant Treatment Models in HIV Care in Uganda
Status:
Completed
Trial end date:
2014-12-01
Target enrollment:
Participant gender:
Summary
This study compares two models for implementing antidepressant treatment in 10 HIV clinics in
Uganda. Using a cluster randomization, 5 clinics implement a task-shifting, protocolized
model, and 5 others rely on clinical acumen. The protocolized model includes (1) routine
depression screening at each clinic visit for all adult patients by trained expert patients
at triage, (2) training nurses to diagnose depression and prescribe and monitor
antidepressant treatment using an algorithm-based protocol, and (3) monthly supervision and
monitoring by hired study psychiatrists. The clinical acumen model also includes routine
depression screening and ongoing supervision, but it relies on the clinical acumen of trained
primary care providers to further evaluate and treat patients who show signs of depression at
screening, as opposed to a structured protocol. The primary aim is to test the hypothesis
that the nurse-driven protocolized model will result in greater uptake of antidepressant
treatment and better quality of depression care outcomes. The study will also test the
hypotheses that treatment of depression results in improved HIV treatment adherence, work
functioning and consistent condom use.