Use of a Medication Management Algorithm in Depressed Youth Living with HIV: Secondary Analysis of a Multisite Randomized Controlled Trial

Abstract

Objectives:

Depression is a prevalent co-occurring condition in youth living with HIV. This report is a secondary analysis of a multisite cluster randomized trial evaluating the efficacy of a health and wellness cognitive behavioral therapy (CBT) combined with a medication management algorithm utilizing measure-based care (COMB-R) compared with enhanced standard of care (ESC). We describe and compare antidepressant prescribing strategies (i.e., antidepressant treatment, type of antidepressant) for youth living with HIV at COMB-R sites to those at ESC sites over the 24-week intervention. We also describe self-reported adherence to antidepressants.

Methods:

Participants (12–24 years) were youth living with HIV diagnosed with moderate to severe depression (Quick Inventory of Depressive Symptomatology [QIDS], Clinician-Rated score ≥11). Thirteen sites were randomly assigned to either the COMB-R arm or the ESC arm. Site-level means were compared using t-tests.

Results:

While there was no difference at baseline in prescribing antidepressants, there was a significantly higher mean percentage of SSRI use at the COMB-R sites at week 24, compared with ESC sites (49.1% vs. 24.2%, p = 0.009). Although the COMB-R group had better outcomes on response and remission by week 24, there were no consistent within-group patterns in depression outcomes by group based on antidepressant treatment. The two groups differed in adherence in the last 30 days, with the COMB-R group reporting more missed medication.

Conclusions:

Our results support the use of the medication management algorithm and measure-based care for the treatment of depression in youth living with HIV. Although treating depression, particularly in youth living with HIV, remains very complex, these findings provide some potential factors to guide future research. Overall, this report supports the importance of medication management in the context of a collaborative treatment model with CBT in improving depression outcomes.