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 Bangsberg

Research output: Contribution to journalArticle

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Abstract

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
Volume103
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

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Antidepressive Agents
Randomized Controlled Trials
HIV
Depression
Fluoxetine
Confidence Intervals
Odds Ratio
Equipment and Supplies
San Francisco
Viral RNA
Vulnerable Populations
Depressive Disorder
HIV-1
Therapeutics

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults : A randomized controlled trial. / Tsai, Alexander C.; Karasic, Dan H.; Hammer, Gwendolyn P.; Charlebois, Edwin D.; Ragland, Kathy; Moss, Andrew R.; Sorensen, James L.; Dilley, James W.; Bangsberg, David.

In: American Journal of Public Health, Vol. 103, No. 2, 02.2013, p. 308-315.

Research output: Contribution to journalArticle

Tsai, Alexander C. ; Karasic, Dan H. ; Hammer, Gwendolyn P. ; Charlebois, Edwin D. ; Ragland, Kathy ; Moss, Andrew R. ; Sorensen, James L. ; Dilley, James W. ; Bangsberg, David. / Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults : A randomized controlled trial. In: American Journal of Public Health. 2013 ; Vol. 103, No. 2. pp. 308-315.
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