| Titre : | Directly Observed Antidepressant Medication Treatment and HIV Outcomes Among Homeless and Marginally Housed HIV-Positive Adults : A Randomized Controlled Trial. (2013) |
| Auteurs : | TSAI (Alexander-C) : USA. Langley Porter Psychiatric Institute. University of California. San Francisco. ; David-R BANGSBERG ; Edwin-D CHARLEBOIS ; James-W DILLEY ; Gwendolyn-P HAMMER ; Dan-H KARASIC ; Andrew-R MOSS ; Kathy RAGLAND ; James-L SORENSEN ; Department of Psychiatry. San Francisco General Hospital. University of California. San Francisco. USA ; Epidemiology and Prevention Interventions Center. Division of Infectious Diseases. San Francisco General Hospital. University of California. San Francisco. USA |
| Type de document : | Article |
| Dans : | American journal of public health (vol. 103, n° 2, 2013) |
| Pagination : | 308-315 |
| Langues: | Anglais |
| Mots-clés : | Sida ; Médicament antituberculeux ; Thérapeutique médicamenteuse ; Chimiothérapie ; Observance thérapeutique ; Antidépresseur ; Médicament ; VIH ; Evolution ; Pronostic ; Thérapeutique ; Sans domicile fixe ; Adulte ; Essai thérapeutique ; Randomisation ; Médicament psychotrope ; Virose ; Infection ; Rétrovirus ; Virus ; Homme ; Immunopathologie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS F7R0xH97. Diffusion soumise à autorisation]. Objectives. 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. Methods. 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). Results. 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. Conclusions. 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. |
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