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Does Problematic Substance Use Moderate Efficacy of Cognitive Behavioral Therapy for Adherence and Depression in HIV?

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Abstract

Problematic substance use may attenuate the effect of treating depression in people living with HIV (PLWH). We examined the potential moderating effect of problematic substance use on depression and adherence outcomes in PLWH (N = 143) who participated in a randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) and were randomized to either CBT-AD or enhanced treatment as usual (ETAU). Problematic substance use was operationalized as either having substance use-related diagnosis or current substance use in the past 30 days with a lifetime history of problematic use. Acute (baseline to 4-month) and follow up (4, 8, and 12-month) general linear modeling with time, condition, problematic baseline substance use, and corresponding interactions demonstrated that substance use did not significantly moderate the effects of CBT-AD on adherence or depression improvements. Therefore, CBT-AD was beneficial for PLWH with depression, regardless of problematic substance use when starting depression treatment. Based on these results, clinicians should not withhold CBT treatment for depression in patients with HIV and problematic substance use to attain reductions in depression and gains in adherence.

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Acknowledgements

Research reported in this publication was supported by a National Institute of Mental Health grant R01XXXXX. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. Some of the author time, and resources for statistical consultation, were also supported by grants National Institute of Allergy and Infectious Diseases (NIAID) XXXXX and P30XXXXX. This study was also funded by a National Institute of Mental Health grant P30XXXXX and National Institute of Drug Abuse grant K24XXXX.

Funding

This study was funded by a National Institute of Mental Health grant R01MH084757 to Dr. Safren. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. Some of the author time, and resources for statistical consultation, were also supported by grants National Institute of Allergy and Infectious Diseases (NIAID) P30AI042853 and the National Institute for Minority Health and Health Disparities (NIMHD) K23MD015690. This study was also funded by a National Institute of Mental Health grant P30MH11687 and National Institute of Drug Abuse grant K24DA040489.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, Miami, USA

    Jasmyn N. Sanders, Tiffany R. Glynn, Daniel Mayo, Sannisha K. Dale & Steven A. Safren

  2. Massachusetts General Hospital, Boston, USA

    Tiffany R. Glynn

  3. Department of Public Health Sciences, University of Miami, Miami, USA

    Audrey Harkness

Authors
  1. Jasmyn N. Sanders
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  2. Tiffany R. Glynn
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  3. Daniel Mayo
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  4. Sannisha K. Dale
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  5. Audrey Harkness
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  6. Steven A. Safren
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Contributions

SAS conceptualized the parent study and provided the data. SAS and JNS conceptualized the current study, and JNS completed this project as part of her master’s thesis. TRG directed and oversaw the statistical analyses. DM assisted with writing the introduction section. SKD and AH provided suggestions and edits throughout many phases of this project.

Corresponding author

Correspondence to Steven A. Safren.

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Conflicts of Interest/competing Interests

Dr. Safren receives royalties from Oxford University Press, Guilford Publications, and Springer/Humana Press on books related to the delivery of cognitive behavioral treatments, such as the one described in this article.

Ethics Approval

All study procedures were approved and reviewed by the respective institutional review boards (IRBs) at the Miriam Hospital, Fenway Health, and Massachusetts General Hospital.

Consent to Participate

Participants were recruited from three HIV clinics and community self-referral (e.g., advertisements on internet sites and newspapers). In addition, two of the clinics (Fenway Health and Massachusetts General Hospital) utilized the patient health questionnaire-2 (PHQ-2) to screen their patients for depression during clinic visits. Patients who scored two or greater, which indicated possible depression, were invited to participate. Interested patients completed a pre-consent screening over the phone (or in-person), and then potential participants were scheduled for a full baseline visit to determine their study eligibility. To participate, eligible participants also completed an informed consent process at the baseline visit; those unwilling or unable to provide informed consent were excluded.

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Supplementary Material 1

Appendix

Appendix

Table 2 Acute Analyses of MEMSa
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Table 3 Acute Analyses of CESDb
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Table 4 Acute Analyses of CGIc
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Table 5 Acute Analyses of MADRSd
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Table 6 Follow-up Analyses of MEMSa
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Table 7 Follow-up Analyses of CESDb
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Table 8 Follow-up Analyses of CGIc
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Table 9 Follow-up Analyses of MADRSd
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Sanders, J.N., Glynn, T.R., Mayo, D. et al. Does Problematic Substance Use Moderate Efficacy of Cognitive Behavioral Therapy for Adherence and Depression in HIV?. AIDS Behav 27, 1123–1132 (2023). https://doi.org/10.1007/s10461-022-03849-5

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