Directly Observed Antidepressant Medication Treatment and HIV Outcomes Among Homeless and Marginally Housed HIV-Positive Adults: A Randomized Controlled Trial

We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008. We conducted a nonblinded, randomized controlled trial of once-weekly flu...

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Bibliographic Details
Published in:	American journal of public health (1971) Vol. 103; no. 2; pp. 308 - 315
Main Authors:	TSAI, Alexander C, KARASIC, Dan H, HAMMER, Gwendolyn P, CHARLEBOIS, Edwin D, RAGLAND, Kathy, MOSS, Andrew R, SORENSEN, James L, DILLEY, James W, BANGSBERG, David R
Format:	Journal Article
Language:	English
Published:	Washington, DC American Public Health Association 01-02-2013
Subjects:	Acquired immune deficiency syndrome Adult AIDS Anti-Retroviral Agents - therapeutic use Antidepressants Antidepressive Agents, Second-Generation - therapeutic use Biological and medical sciences Bipolar disorder CD4 Lymphocyte Count CD4-Positive T-Lymphocytes - immunology Clinical trials Cohort Studies Comorbidity Depressive Disorder - drug therapy Drug use Female Fluoxetine - therapeutic use Follow-Up Studies General aspects HIV HIV - isolation & purification HIV Infections - drug therapy HIV Infections - immunology HIV Infections - virology Homeless people Homeless Persons Human immunodeficiency virus Human viral diseases Humans Infectious diseases Intervention Lymphocytes Male Medical sciences Medication Adherence Mental depression Middle Aged Miscellaneous Neuropharmacology Patient compliance Pharmacology. Drug treatments Psychiatrists Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) Psychology. Psychoanalysis. Psychiatry Psychopharmacology Public health Public health. Hygiene Public health. Hygiene-occupational medicine Remission (Medicine) Research and Practice San Francisco Severity of Illness Index Substance abuse treatment Treatment Outcome Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Viral Load - drug effects San Francisco Prognosis Psychotropic Drug compliance Randomization Adult Antidepressant agent Clinical trial Evolution Treatment compliance Antituberculous agent Public health Human Drug Immunopathology Retroviridae AIDS Immune deficiency Lentivirus Infection Virus Chemotherapy Homeless Treatment Viral disease Human immunodeficiency virus
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Summary:	We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008. We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive disorder or dysthymia). Hamilton Depression Rating Scale score was the primary outcome. Response was a 50% reduction from baseline and remission a score below 8. Secondary measures were Beck Depression Inventory-II (BDI-II) score, antiretroviral uptake, antiretroviral adherence (measured by unannounced pill count), and HIV-1 RNA viral suppression (< 50 copies/mL). The intervention reduced depression symptom severity (b = -1.97; 95% confidence interval [CI] = -0.85, -3.08; P < .001) and increased response (adjusted odds ratio [AOR] = 2.40; 95% CI = 1.86, 3.10; P < .001) and remission (AOR = 2.97; 95% CI = 1.29, 3.87; P < .001). BDI-II results were similar. We observed no statistically significant differences in secondary HIV outcomes. Directly observed fluoxetine may be an effective depression treatment strategy for HIV-positive homeless and marginally housed adults, a vulnerable population with multiple barriers to adherence.
Bibliography:	A. C. Tsai, D. H. Karasic, G. P. Hammer, E. D. Charlebois, A. R. Moss, J. L. Sorensen, J. W. Dilley, and D. R. Bangsberg conceptualized and designed the study. D. R. Bangsberg acquired data and obtained funding. A. C. Tsai, K. Ragland, and D. R. Bangsberg analyzed and interpreted the data. A. C. Tsai and K. Ragland did statistical analysis. D. H. Karasic, G. P. Hammer, E. D. Charlebois, J. L. Sorensen, J. W. Dilley, and D. R. Bangsberg provided administrative support. A. R. Moss provided supervision. A. C. Tsai drafted the article, and all authors critically revised it. Peer Reviewed Contributors
ISSN:	0090-0036 1541-0048
DOI:	10.2105/AJPH.2011.300422