IMPAACT 2002: Cognitive Behavioral Therapy and Medication Management for Treatment of Depression in US Youth With HIV

NCT ID: NCT02939131

Last Updated: 2021-03-03

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

156 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-03-06

Study Completion Date

2020-01-21

Brief Summary

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IMPAACT 2002 is a prospective, multi-site, two-arm, cluster-randomized study to evaluate whether a health and wellness Cognitive Behavioral Therapy and Medication Management (COMB-R) intervention for depression demonstrates improved depression and medical outcomes for HIV-infected youth in the United States (US) compared to enhanced standard care (ESC).

Detailed Description

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IMPAACT 2002 was a prospective, multi-site, two-arm, cluster-randomized study that evaluated whether a health and wellness Cognitive Behavioral Therapy and Medication Management (COMB-R) intervention for depression demonstrated improved depression outcomes (e.g., decreased depressive symptoms and greater remission and response rates) and medical outcomes (e.g., increased cluster of differentiation 4 (CD4) T-cell count, decreased HIV RNA level) among HIV-infected youth in the US compared to enhanced standard care (ESC). Sites were randomized to either the COMB-R intervention or the ESC control arm. Youth enrolled in the study attended a Screening/Entry Visit and study visits at Weeks 1, 6, 12, and 24. They had two additional follow-up visits at Weeks 36 and 48 for the study team to evaluate if observed effects of the intervention were maintained. The intervention was a treatment for depression that included a manualized Health and Wellness Cognitive Behavioral Therapy and an algorithm-driven Medication Management designed to address the unique challenges faced by this population.

Conditions

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HIV Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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COMB-R

Health and Wellness Cognitive Behavioral Therapy and Medication Management (COMB-R) intervention

Group Type EXPERIMENTAL

Health and Wellness Combined Cognitive Behavioral Therapy and a Medication Management Algorithm

Intervention Type BEHAVIORAL

Behavioral therapy based on a manualized approach developed specifically for youth living with both HIV and depression, using problem-solving, motivational interviewing and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The medication management algorithm includes guidance for clinicians on strategies and tactics to treat depression in this population, including factors to consider when deciding on treatments (i.e., drug-drug interactions, side effects).

Enhanced Standard of Care

Enhanced Standard of Care (ESC)

Group Type ACTIVE_COMPARATOR

Enhanced Standard of Care

Intervention Type BEHAVIORAL

Ongoing psychopharmacological and psychosocial counseling and treatment for depression at HIV clinical treatment centers enhanced by providing clinicians with up-to-date information and didactic training on current principles for use of medication and psychotherapy in the treatment of depression.

Interventions

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Health and Wellness Combined Cognitive Behavioral Therapy and a Medication Management Algorithm

Behavioral therapy based on a manualized approach developed specifically for youth living with both HIV and depression, using problem-solving, motivational interviewing and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The medication management algorithm includes guidance for clinicians on strategies and tactics to treat depression in this population, including factors to consider when deciding on treatments (i.e., drug-drug interactions, side effects).

Intervention Type BEHAVIORAL

Enhanced Standard of Care

Ongoing psychopharmacological and psychosocial counseling and treatment for depression at HIV clinical treatment centers enhanced by providing clinicians with up-to-date information and didactic training on current principles for use of medication and psychotherapy in the treatment of depression.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Receiving mental health or HIV-related care at participating US IMPAACT site
* Confirmed HIV-1 Infection
* Aware of his or her HIV infection
* Per clinician assessment, primary diagnosis of nonpsychotic depression, including Major Depressive Disorder, Depression Not Otherwise Specified (NOS), or Dysthymia, as defined by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV or DSM-V criteria
* Current depressive symptoms that warrant intervention as determined by a score of ≥ 11 on the Quick Inventory of Depressive Symptomatology - Clinician (QIDS-C)
* Able to communicate in spoken and written English
* Able and willing to provide written informed assent/consent and able to obtain written parental or guardian permission (if required, as specified in site standard operating procedure (SOP), by State law, and/or Institutional Review Board (IRB) policy) to be screened for and to enroll in IMPAACT 2002

Exclusion Criteria

* Known or self-reported history of any psychotic disorder and/or bipolar I or II disorder
* Severe disorders (more than 6 symptoms) based on DSM-V criteria related to alcohol, cannabis or other substances; or those with moderate symptoms (4 or 5 symptoms) who are also currently experiencing withdrawal or dependence symptoms; within the past month prior to enrollment
* Per clinician assessment at screening, depression and/or suicidal ideation requiring more intensive treatment than the study provides or at immediate risk of being a danger to themselves or others
* Per participant report at screening, intends to relocate away from the study site during study participation
* Currently in therapy with a non-study provider, unless willing to switch to a study-trained provider
* Has any other condition that, in the opinion of the Investigator of Record (IoR)/designee, would preclude informed assent/consent, make study participation unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives
Minimum Eligible Age

12 Years

Maximum Eligible Age

24 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

International Maternal Pediatric Adolescent AIDS Clinical Trials Group

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Larry Brown, MD

Role: STUDY_CHAIR

Rhode Island Hospital; Brown University

Locations

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University of Southern California - MCA Center (CRS 5048),

Alhambra, California, United States

Site Status

University California, San Diego (CRS 4601)

La Jolla, California, United States

Site Status

David Geffen School of Medicine at UCLA (CRS 5112)

Los Angeles, California, United States

Site Status

Children's Hospital of Colorado (CRS 5052)

Aurora, Colorado, United States

Site Status

Children's Diagnostic and Treatment Center (CRS 5055)

Fort Lauderdale, Florida, United States

Site Status

Emory University School of Medicine (CRS 5030)

Atlanta, Georgia, United States

Site Status

Rush University Medical Center (CRS 5083)

Chicago, Illinois, United States

Site Status

Johns Hopkins University School of Medicine (CRS 5092)

Baltimore, Maryland, United States

Site Status

Stony Brook University Medical Center (CRS 5040)

Stony Brook, New York, United States

Site Status

Bronx-Lebanon Hospital Center (CRS 5114)

The Bronx, New York, United States

Site Status

Jacobi Medical Center (CRS 5013)

The Bronx, New York, United States

Site Status

St Jude Children's Research Hospital (CRS 6501)

Memphis, Tennessee, United States

Site Status

Texas Children's/Baylor (CRS 3801)

Houston, Texas, United States

Site Status

Countries

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United States

References

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Brown LK, Kennard BD, Emslie GJ, Mayes TL, Whiteley LB, Bethel J, Xu J, Thornton S, Tanney MR, Hawkins LA, Garvie PA, Subramaniam GA, Worrell CJ, Stoff LW; Adolescent Trials Network for HIVAIDS Interventions. Effective Treatment of Depressive Disorders in Medical Clinics for Adolescents and Young Adults Living With HIV: A Controlled Trial. J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):38-46. doi: 10.1097/QAI.0000000000000803.

Reference Type BACKGROUND
PMID: 26761270 (View on PubMed)

Bernstein IH, Rush AJ, Trivedi MH, Hughes CW, Macleod L, Witte BP, Jain S, Mayes TL, Emslie GJ. Psychometric properties of the Quick Inventory of Depressive Symptomatology in adolescents. Int J Methods Psychiatr Res. 2010 Dec;19(4):185-94. doi: 10.1002/mpr.321.

Reference Type BACKGROUND
PMID: 20683845 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Document Type: Study Protocol and Informed Consent Form

View Document

Related Links

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https://rsc.niaid.nih.gov/clinical-research-sites/daids-adverse-event-grading-tables

The Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events (AE) (DAIDS AE Grading Table), Corrected Version 2.1, July 2017

https://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf

Richard M Selik, Eve D Mokotoff, Bernard Branson, et al. Revised Surveillance Case Definition for HIV Infection - United States, 2014. Morbidity and Mortality Weekly Report (MMWR) 2014; 63 (No. 3):7

http://rsc.niaid.nih.gov/clinical-research-sites/manual-expedited-reporting-adverse-events-daids

Manual for Expedited Reporting of Adverse Events to DAIDS (DAIDS Expedited Adverse Events (EAE) Manual), Version 2.0, January 2010

Other Identifiers

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UM1AI068632

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UM1AI068616

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UM1AI106716

Identifier Type: NIH

Identifier Source: secondary_id

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IMPAACT 2002

Identifier Type: -

Identifier Source: org_study_id

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