Latinos are disproportionately impacted by the domestic HIV epidemic and untreated mental health problems continue to be a major public health challenge. Untreated mental health problems are driving poor outcomes along the HIV Care Continuum and impeding efforts to reduce health disparities and new infections. An adaptive treatment strategy integrated into HIV care and that uses a mobile health approach is an innovative way to more effectively treat depression and improve HIV treatment outcomes among Latinos living with HIV.
The overall goal of this K01 is to use a SMART to build an adaptive treatment strategy (ATS) that has a mobile health tool to improve adherence to the treatments for depression that are being proposed, and then evaluate the SMART and ATS through an implementation science model. The treatments being tested are a behavioral activation therapy (BAT), a cognitive-behavioral therapy (CBT), and mobile health (mHealth) tool (i.e., text-messaging protocol). The outcomes are to assess the feasibility of the SMART and ATS in the HIV care site and acceptability of the SMART and ATS to patients and clinic staff. To achieve the overall goal, three specific aims are outlined.
Aim 1 uses qualitative research methods for the conduct of focus groups and individual interviews with HIV+ Latinos in both English and Spanish. The goal of Aim 1 is to tailor the intervention to the cultural and linguistic needs of Latinos and the organization needs of the HIV clinic study site, which informs Aim 2. Aim 1 is guided by the CDCs Map of Adaptation tailoring framework, which consist of three Action Steps. Action Step 1-3 are to better understand and document:
1) expressions for depression in Spanish and barriers to care,
2) language issues in detecting and reporting depressive symptoms,
3) cultural perspectives of how depression presents as a barrier to care, and
4) attitudes (i.e., cognitive and emotional evaluations) toward BAT and CBT, and text- message preference and confidentiality concerns to promote adherence to the intervention activities.
Aim 2 is to build and test a pilot SMART. An ATS is a set of decision rules that uses detectable changes in patient health status to inform the next course of treatment. Aim 3 is to determine an adoption, implementation, and sustainability plan for adaptive depression treatment strategies into HIV care settings. Aim 3 is guided by the Capability, Opportunity, and Motivation System (COM-B) system and related Behavioral Change Wheel.