Implementing Depression and Adherence Treatment in South Africa HIV Care
University of Miami
Summary
The goal of this clinical trial is to compare a core set and enhanced set of implementation strategies in increasing the reach of evidence-based treatments to patients with HIV and depression. The main questions it aims to answer are: What proportion of patients start an evidence-based treatment for depression (reach)? What percentage of patients show clinical improvement in depression and what percentage attain viral undetectability within one year (effectiveness)? Researchers will compare high and low reach clinics to further inform tailored implementation strategies for uptake and maintenance. Clinics will be randomized into one of two study arms: core versus enhanced strategies. In both arms, core strategies will be utilized. Enhanced clinics will also receive more resource-intensive training.
Description
Objectives: Our primary objective is to compare a core set to an enhanced set of implementation strategies for extending the reach of evidence-based treatments for depression to patients with uncontrolled HIV in South Africa (SA) HIV care settings. Using RE-AIM as the implementation outcome framework, the primary outcome is reach, defined as the percent of patients who start an evidence-based treatment for depression (i.e., CBT-AD and/or psychopharmacotherapy). To further inform optimal implementation strategies, we will also examine possible moderators and mediators of implementation outcom…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria for Clinics (the primary "participants"): * Clinics are eligible if they provide HIV primary care via the City of Cape Town (CoCT) Department of Health * Clinics will be assigned to the study upon notice of funding and before start up. Inclusion Criteria for Patient-level Outcomes: Although the unit of randomization is at the clinic level, the study will be looking at adult patient level data at each clinic. All patients engaged in care at one of the 10 primary care/HIV treatment clinics in the study will be included if they: * Are 18 years of age or older and * Have a d…
Interventions
- OtherCore Implementation Strategies
* Task Sharing/Revise Professional Roles * Distribute educational materials/Dynamic Training/Address Stigma * Clinician Implementation Team Meetings * Partner with CoCT DoH * Champion * Audit and Feedback * Stage Scale Up/Tailoring
- OtherEnhanced Implementation Strategies
* Train the trainer * Ongoing supervision and consultation
Locations (3)
- University of MiamiMiami, Florida
- Massachusetts General HospitalBoston, Massachusetts
- University of Cape TownCape Town