A Randomized Controlled Trial of Telephone-Administered Interpersonal Psychotherapy (IPT) for Depressed Rural Persons Living with HIV/AIDS

1
A Randomized Controlled Trial of
Telephone-Administered Interpersonal
Psychotherapy (IPT) for Depressed Rural Persons
Living with HIV/AIDS Amanda Kocoloski, OMS IV
Timothy Heckman, Ph.D. Bernadette Heckman,
Ph.D. Timothy Anderson, Ph.D.
Victor Heh, Ph.D. Mark Sutton, LSW OU-COM
Center for Telemedicine Research and
Interventions, Athens, OH.
Abstract
Data
Methods
Discussion

• If telephone-administered IPT is shown to be
  effective, the research team will develop a
  manual that describes how to provide IPT over the
  phone and disseminate it free of charge to
  organizations and individuals working with HIV
  depressed individuals living in rural communities

Introduction HIV-infected rural persons
experience elevated rates of depression, suicidal
ideation, stigma/discrimination, lack access to
contemporary medical and mental health services,
and have difficulty adhering consistently to
regimens of antiretroviral therapy (ART).1,2,3
Cost-effective and easily accessible mental
health services are urgently needed for
HIV-infected rural persons. Background Project
Alliance is a randomized controlled trial of the
effectiveness of telephone-administered IPT in
reducing depressive symptoms in depressed
HIV-infected rural persons compared to a standard
of care (SOC) control condition. Methodology
Participants depressive symptoms, interpersonal
problems, social supports, and adherence to ART
are being assessed at pre- and post-intervention
and 4- and 8-month follow-up. The project will
enroll 180 participants 90 will receive 9
sessions of telephone IPT and 90 SOC controls
will receive psychosocial services available in
their home communities. To date, 40 eligible
participants have been identified. Demographic
information on these 40 participants is provided
in Figures 2a-c. Conclusion Preliminary
intervention-outcome analyses will report on
short-term changes associated with the IPT
intervention.

• Participants are being recruited from 6 types of
  counties designated as nonmetropolitan by the
  U.S. Department of Agriculture
• Methods of recruitment include contacting AIDS
  service organizations (ASOs) throughout the
  nation and information disseminated by the Rural
  Center for AIDS Prevention (RCAP) at Indiana
  University
• Upon receipt of the signed consent form,
  potential participants are screened for
  eligibility

Figure 1. Participant Recruitment and Screening

• 554- Completed initial screening
• 303- Satisfied rural criterion
• 225- Informed consents returned

55- Completed eligibility interviews 40-
Eligible and enrolled 10- Baselines completed
References

1. Sheth, S.H., Jensen, P.T., Lahey, T. (2009).
   Living in rural New England amplifies the risk of
   depression in patients with HIV. BMC Infectious
   Diseases, 925. also retrieved at
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2. Reif, S., Whetten, K., Ostermann, J., Raper,
   J.L. (2006). Characteristics of HIVinfected
   adults in the Deep South and their utilization of
   mental health services A rural vs. urban
   comparison. AIDS Care, 18, 10-17.
3. Reif, S., Golin, C.E., Smith, S.R. (2005).
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   Carolina Rural and urban differences. AIDS Care,
   17, 558-565.
4. Lahey, T., Lin, M., Marsh, B., Curtin, J., Wood,
   K., Eccles, B., von Reyn, C.F. (2007). Increased
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5. Wilfley, D.E., MacKenzie, K.R., Welch, R.R.,
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   et al. (1997). HIV-prevention group counseling
   delivered by telephone An efficacy trial with
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6. Elkin, I., Shea, M.T., Watkins, J.T., Imber,
   S.D., Sotsky, S.M., Collins, J.F et al. (1989).
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10. Bordin, E.S. (1979). The generalizability of the
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11. Ransom, D., Heckman, T.G., Anderson, T., Garske,
    J., Holroyd, K., Basta, T. (2008).
    Telephone-delivered, interpersonal psychotherapy
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Table 1. Inclusion Criteria
Figures 2a-c. Demographics of Individuals
Currently Eligible and Enrolled (n 40)
Age 18 HIV/AIDS Rural status
MDD, partial remission of MDD, or dysthymia Rural residence for next 12 months Informed consent
2a. Gender
MDD major depressive disorder U.S. Department
of Agriculture Rural-Urban Continuum Code of 4
(with population lt70,000), 5, 6, 7, 8, or 9.
Table 2. Exclusion Criteria
Introduction
2b. Sexuality
2c. Ethnicity
Serious cognitive or neuropsychiatric impairment

• Compared to urban counterparts, rural HIV
  individuals are more likely to be diagnosed with
  depression, less likely to visit mental health
  professionals, and have significantly shorter
  survival periods1,2,4
• Interpersonal psychotherapy (IPT) is ideal for
  depressed individuals with HIV/AIDS due to its
  short duration and emphasis on current
  interpersonal relationships5
• Face-to-face IPT has been shown to be as
  efficacious as psychotherapy and antidepressant
  medication in reducing depression6
• Previous telemedicine in the HIV/AIDS population
  has focused on reducing risky sexual behaviors,
  improving treatment adherence, and enhancing
  quality of life7,8,9
• Therapeutic alliance refers to the positive bond
  between the client and therapist, a consensus on
  the goals of therapy, and the collaborative
  engagement in the tasks of therapy10 it is
  currently unclear if alliance can be established
  and maintained over the telephone
• Despite several limitations, a pilot RCT of
  telephone-administered IPT did show reduction in
  depressive symptoms in HIV-infected rural
  individuals11

• Eligible individuals are mailed a baseline survey
  to assess
• Depressive symptoms according to the Beck
  Depression Inventory (primary outcome)
• Interpersonal problems (Inventory of Personal
  Problems)
• Social supports (Provision of Social Relations)
• Adherence to ART (ART Treatment Adherence)
• Participants are randomized to SOC or IPT SOC
• IPT SOC receive 9 weekly hour-long sessions of
  telephone-administered IPT from trained therapist
• On a weekly basis, all participants complete the
  Self-Assessing Depression Scale (SADS) using the
  interactive voice response (IVR) system
• IPT SOC participants also complete the Working
  Alliance Inventory to assess alliance
• Surveys are being completed by all participants
  post-intervention and at 4 and 8 month follow-up
  intervals
• Preliminary intervention-outcome analyses will
  report on short-term changes associated with the
  IPT intervention

Discussion

• Telephone-administered mental health
  interventions for depressed rural individuals are
  appealing to help overcome geographical barriers,
  maximize confidentiality, and to create emotional
  support systems12
• Telepsychiatry is effective in treating
  depressive disorders13
• Face-to-face IPT is as efficacious as
  antidepressant medication and psychotherapy in
  reducing depression in HIV individuals6
• This RCT will fill gaps in the literature
  regarding the effectiveness of telephone-administe
  red IPT on HIV rural individuals depressive
  symptoms, interpersonal problems, social
  supports, and adherence to ART

Acknowledgements

• We would like to thank the NIH for their generous
  funding that made this study possible