Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: A randomized controlled trial

Alexander C. Tsai, Dan H. Karasic, Gwendolyn P. Hammer, Edwin D. Charlebois, Kathy Ragland, Andrew R. Moss, James L. Sorensen, James W. Dilley, David R. Bangsberg

Research output: Contribution to journalArticle

45 Scopus citations


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 onceweekly 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.

Original languageEnglish (US)
Pages (from-to)308-315
Number of pages8
JournalAmerican journal of public health
Issue number2
StatePublished - Feb 1 2013


ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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