Authors:
Jacob T. Painter, Jeffrey Pyne, Geoffrey Curran, Rebecca A. Raciborski, Shane Russell, John Fortney, Allen L. Gifford, Michael Ohl & Eva N. Woodward
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: September 2024
Read the full text in the open access journal Implementation Science Communications
Abstract:
Background
Depression is the most diagnosed mental health condition among people living with HIV. Collaborative care is an effective intervention for depression, typically delivered in primary care settings. The HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) clinical intervention involves a depression care team housed off-site that supports depression care delivery by HIV care providers. In a randomized controlled trial, HITIDES significantly improved depression symptoms for veterans living with HIV and delivered cost savings. However, no HIV clinics in the Veterans Health Administration (VHA) have implemented HITIDES; as such, it is unclear what implementation strategies are necessary to launch and sustain this intervention.
Methods
This hybrid type-3 effectiveness-implementation trial examines the implementation and effectiveness of HITIDES in 8 VHA HIV clinics randomly assigned to one of two implementation arms. Each arm uses a different implementation strategy package. Arm 1 includes an intervention operations guide; an on-site clinical champion who, with the help of a peer community of practice, will work with local clinicians and leadership to implement HITIDES at their site; and patient engagement in implementation tools. Arm 2 includes all strategies from Arm 1 with assistance from an external facilitator. The primary implementation outcomes is reach; secondary outcomes include adoption, implementation dose, depressive symptoms, and suicidal ideation. We will conduct a budget impact analysis of the implementation strategy packages. We hypothesize that Arm 2 will be associated with greater reach and adoption and that Arm 1 will be less costly.
Discussion
Preliminary work identified implementation strategies acceptable to veterans living with HIV and HIV care providers; however, the effectiveness and cost of these strategies are unknown. While the depression care team can deliver services consistently with high quality, the ability of the depression care team to engage with HIV care providers at sites is unknown. Findings from this study will be used to inform selection of implementation strategies for a broad rollout to enhance depression and suicide care for people living with HIV.
Trial registration
ClinicalTrials.gov ID: NCT05901272, Registered 10 May 2023, https://clinicaltrials.gov/study/NCT05901272
Contributions to the literature
- It is well-recognized that those with HIV infections need greater access to mental healthcare for depression. But it is not known how best to support deployment of evidence-based mental healthcare to them.
- This paper describes an implementation trial to roll out depression care in HIV clinics.
- With the fragmentation of care among so many subspecialties, understanding how to roll out mental health support across specialty medical settings is crucial.
- Results will be relevant to mental health and suicide support not only for those with HIV but across many sectors of care for adults receiving care in specialty medical settings.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**