e-SMART/EST HIV Telehealth Intervention

Depression Clinical Trial

— eSMARTEST  

Official title:

e-SMART/EST Telehealth Intervention to Reduce Depression in Older Women With HIV

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05278572
• Other study ID #: 2021-13391
• Status: Completed
• Phase: N/A
• Start date: January 25, 2023
• Est. completion date: April 5, 2023

Study information

• Verified date: April 2023
• Source: Albert Einstein College of Medicine
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this project is to adapt an evidence-based, enhanced cognitive-behavioral stress management intervention (CSBM+) to target depression among older HIV-positive women in the Bronx, New York. The intervention, "Stress Management and Relaxation Training/Expressive Supportive Therapy" (SMART/EST), demonstrated effectiveness in numerous iterations over 15+ years, including trials with racially diverse HIV-positive women. To meet changing community needs including moving behavioral interventions to telehealth, we will pilot test e-SMART/EST, a teletherapy adaptation with peer support for HIV+ older women.

Description:

HIV-positive older women are a neglected, high-risk population for depression. Depression is the most common psychiatric comorbidity for people living with HIV (PLWH), with prevalence between 20-40% and up to 78% in some cohorts. It has associations with lower CD4 (cluster of differentiation 4 - a type of white blood cell) count, higher viral load, reduced medication adherence, and AIDS-related and all-cause mortality. Among older people living with HIV/AIDS (PLWHA), women are more likely than men to be depressed.

Group teletherapy is an efficacious modality to target depression, including among PLWHA, with improved retention and acceptability. To harness these innovations to improve outcomes for HIV+ older women, we will incorporate community feedback to refine and test an online adaption of SMART/EST, an empirically validated cognitive-behavioral stress management/expressive supportive therapy (CBSM+). SMART/EST is effective with HIV+ women and will likely be translated online given the proliferation of cognitive-behavioral therapy (CBT) teletherapy groups. Results will inform secondary prevention with a growing generation of HIV+ older women.

The original, in-person intervention is a 16-session, two-hour weekly group using CBSM+ to target depression, medication adherence, nutrition, physical activity, harm reduction, smoking, and safer sex. e-SMART/EST will be online, condensed to 8 weekly 1-hour sessions, and will target depression. The study has two phases. In Phase 1, we will obtain scientific, community and expert advice from 8 community peer, scientific, and clinical advisors to adapt existent protocols. In Phase 2, we will conduct a pragmatic single group pre-post trial with 10 participants recruited from Montefiore's Women's Interagency HIV Study (WIHS).

e-SMART/EST will be facilitated on MyChart by a Psychologist (PsyD) with prior experience developing the intervention, and co-facilitated by a community peer and Healthy Aging Specialist with 25+ years of experience in HIV programming. Participants will complete pre- and post-test surveys, as well as provide feedback about feasibility, adaptability, and recommendations to improve the intervention. Statistical analyses include paired-samples t-tests and adaptability/feasibility tests, as well as measures of fidelity.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 10
• Est. completion date: April 5, 2023
• Est. primary completion date: April 5, 2023
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 55 Years to 99 Years

Eligibility

Inclusion Criteria:

• HIV-positive

• Age 55+

• Teletherapy access

• Depression in last 12 months.

• Fluent in English

Exclusion Criteria:

• HIV-negative or HIV-unknown

• Younger than 55 years old

• Lack of depression in last 12 months

• Non-fluent in English

• Opioid use disorder in last 12 months

• Psychotic disorder in last 12 months.

Related Conditions & MeSH terms

• Depression
• Hiv

Intervention

Behavioral:
• Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)
Cognitive-behavioral stress management/expressive supportive therapy (CBSM+) group targeting depression

Locations

Country	Name	City	State
United States	Albert Einstein College of Medicine - Department of Psychiatry and Behavioral Sciences	Bronx	New York

Sponsors (1)

Lead Sponsor	Collaborator
Albert Einstein College of Medicine

Country where clinical trial is conducted

United States, 

References & Publications (9)

Ironson G, Weiss S, Lydston D, Ishii M, Jones D, Asthana D, Tobin J, Lechner S, Laperriere A, Schneiderman N, Antoni M. The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women's — View Citation

Jones DL, Lopez M, Simons H, Diaz-Gloster M, Tobin JN, Weiss SM. Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program. Transl Behav Med. 2013 Dec;3(4):416-25. doi: 10.1007/s13142-013-0213-4. — View Citation

Jones DL, McPherson-Baker S, Lydston D, Camille J, Brondolo E, Tobin JN, Weiss SM. Efficacy of a group medication adherence intervention among HIV positive women: the SMART/EST Women's Project. AIDS Behav. 2007 Jan;11(1):79-86. doi: 10.1007/s10461-006-916 — View Citation

Laperriere A, Ironson GH, Antoni MH, Pomm H, Jones D, Ishii M, Lydston D, Lawrence P, Grossman A, Brondolo E, Cassells A, Tobin JN, Schneiderman N, Weiss SM. Decreased depression up to one year following CBSM+ intervention in depressed women with AIDS: th — View Citation

Segal-Isaacson CJ, Tobin JN, Weiss SM, Brondolo E, Vaughn A, Wang C, Camille J, Gousse Y, Ishii M, Jones D, Laperriere A, Lydston D, Schneiderman N, Ironson G. Improving dietary habits in disadvantaged women with HIV/AIDS: the SMART/EST women's project. A — View Citation

Waldron EM, Burnett-Zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, Tomaszewski E, Miller ES. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care. 2021 Jan-Dec;20:2325958220985665. doi: 10.1177/2325958220985665. — View Citation

Webel AR. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS Care. 2010 Sep;22(9):1029-40. doi: 10.1080/09540120903214389. — View Citation

Weiss SM, Tobin JN, Antoni M, Ironson G, Ishii M, Vaughn A, Cassells A, Jones D, Schneiderman N, Brondolo E, Laperriere A, Lopez M, Villar-Loubet O, Camille J, Kumar M, Page JB; SMART/EST Women's Project Team*. Enhancing the health of women living with HI — View Citation

Weiss SM, Tobin JN, Lopez M, Simons H, Cook R, Jones DL. Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women's Program. Int J Behav Med. 2015 Jun;22(3):415-24. doi: 10.1007/s12529-014 — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Decrease in score from Baseline in Depression on 21-item Beck Depression Inventory (BDI) at Week 9	The Beck Depression Inventory (BDI) is a validated, self-report 21-item scale assessing depression. Response options range from 0-3 for each item. Item scores are summed, with sum scores ranging from 0-63. Higher scores indicate more depression (i.e., worse outcome). Scale scores from 1-10 indicate: These ups and downs are considered normal; 11-16: Mild mood disturbance; 17-20: Borderline clinical depression; 21-30: Moderate depression; 31-40: Severe depression; over 40: Extreme depression.	Baseline and Week 9
Primary	Decrease in score from Baseline in Anxiety on 21-item Beck Anxiety Inventory (BAI) at Week 9	The Beck Anxiety Inventory (BAI) is a validated, self-report 21-item scale assessing anxiety. Response options range from 0-3 for each item. Item scores are summed, with sum scores ranging from 0-63. Higher scores indicate more anxiety (i.e., worse outcome). Scale scores from 0-21 indicate: low anxiety; 22-35: moderate anxiety; 36 and above: potentially concerning levels of anxiety.	Baseline and Week 9

External Links

•   Clinical Directors Network website for previous iterations of the SMART/EST group for HIV-positive women