Integrating evidence-based antidepressant management into HIV primary care: Lessons learned and key questions

Brian Pence, Ph.D., M.P.H.
University of North Carolina-Chapel Hill

ABSTRACT:
Depression is highly prevalent among patients in HIV clinical care.  Depression is a strong risk factor for poor HIV treatment adherence and clinical outcomes, making its effective management an important consideration for HIV patients.  However, depression frequently goes undiagnosed, untreated, or undertreated in HIV care, and patients often face substantial barriers to accessing specialty mental health care, especially in the rural South.  A strong evidence base supports the integration of algorithm-guided decision support for antidepressant management as a cost- and time-efficient way to expand mental health treatment capacity in non-psychiatric clinical settings.  The SLAM DUNC Trial was a randomized trial of antidepressant management decision support integrated into four HIV primary care clinics in the US South.  Results of the trial will be discussed along with screening, uptake, and retention challenges, patient and provider perspectives, and implications for broader implementation efforts.