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Randomized Controlled Trial of a Cognitive-Behavioral Intervention for HIV-Positive Persons: An Investigation of Treatment Effects on Psychosocial Adjustment

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Abstract

Questions remain regarding the clinical utility of psychological interventions for HIV-positive persons because randomized controlled trials have utilized stringent inclusion criteria and focused extensively on gay men. The present randomized controlled trial examined the efficacy of a 15-session, individually delivered cognitive-behavioral intervention (n = 467) compared to a wait-list control (n = 469) in a diverse sample of HIV-positive persons who reported HIV transmission risk behavior. Five intervention sessions that dealt with executing effective coping responses were delivered between baseline and the 5 months post-randomization. Additional assessments were completed through 25 months post-randomization. Despite previously documented reductions in HIV transmission risk, no intervention-related changes in psychosocial adjustment were observed across the 25-month investigation period. In addition, there were no intervention effects on psychosocial adjustment among individuals who presented with mild to moderate depressive symptoms. More intensive mental health interventions may be necessary to improve psychosocial adjustment among HIV-positive individuals.

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Acknowledgements

This research was funded by National Institute of Mental Health grants U10-MH57636, U10- MH57631, U10-MH57616, and U10-MH57615; and NIMH center grants P30-MH058107 (Mary Jane Rotheram-Borus, Ph.D., PI), P30-MH57226 (Jeffrey A. Kelly, Ph.D., PI), P30-MH43520 (Anke A. Ehrhardt, Ph.D., PI), and P30-MH062246 (Thomas J. Coates, Ph.D., PI). Additional support was provided by a Ruth L. Kirschstein National Research Service Award (T32-MH019391).

The authors thank those at NIMH: Ellen Stover, Ph.D, and Willo Pequegnat, Ph.D., for their technical assistance in developing the study and Christopher M. Gordon, Ph.D., and Dianne Rausch, Ph.D., for their support of this research. Gratitude is also given to Susan Tross, Ph.D. and Gary Dowsett, Ph.D. for methodological guidance; to the assessors in each city who conducted the interviews, to our clinic and community based organization collaborators, to all other support staff involved in the project, and to the men and women who participated in the interviews.

This study was conducted by the NIMH Healthy Living Trial Group. Research Steering Committee (site principal investigators and NIMH staff collaborator): Margaret A. Chesney, Ph.D.1, Anke A. Ehrhardt, Ph.D.2, Jeffrey A. Kelly, Ph.D.3, Willo Pequegnat, Ph.D.4, Mary Jane Rotheram-Borus, Ph.D.5 Collaborating Scientists, Co-Principal Investigators, and Investigators: Eric G. Benotsch, Ph.D.3, Michael J. Brondino, Ph.D.3, Sheryl L. Catz, Ph.D.3, Edwin D. Charlebois, Ph.D., M.P.H.1, Don C. DesJarlais, Ph.D.6, Naihua Duan, Ph.D.5, Theresa M. Exner, Ph.D.2, Rise B. Goldstein, Ph.D., M.P.H.5, Cheryl Gore-Felton, Ph.D.3, A. Elizabeth Hirky, Ph.D.2, Mallory O. Johnson, Ph.D.1, Robert M. Kertzner, M.D.2, Sheri B. Kirshenbaum, Ph.D.2, Lauren E. Kittel, Psy.D.2, Robert Klitzman, M.D.2, Martha Lee, Ph.D.5, Bruce Levin, Ph.D.2, Marguerita Lightfoot, Ph.D.5, Stephen F. Morin, Ph.D.1, Steven D. Pinkerton, Ph.D.3, Robert H. Remien, Ph.D.2, Fen Rhodes, Ph.D.5, Susan Tross, Ph.D.2, Lance S. Weinhardt, Ph.D.3, Robert Weiss, Ph.D.5, Hannah Wolfe, Ph.D.7, Rachel Wolfe, Ph.D.7, Lennie Wong, Ph.D.5 Data Management and Analytic Support: Philip Batterham, M.A.5, Tyson Rogers, M.A.5 Site Project Coordinators: Kristin Hackl, M.S.W.3, Daniel Hong, M.A.5, Karen Huchting, B.A.5, Joanne D. Mickalian, M.A.1, Margaret Peterson, M.S.W.3, NIMH: Christopher M. Gordon, Ph.D.4, Dianne Rausch, Ph.D.4, Ellen Stover, Ph.D.4

1 University of California, San Francisco; 2 New York State Psychiatric Institute/Columbia University, New York; 3 Medical College of Wisconsin, Milwaukee; 4 National Institute of Mental Health, Bethesda, Maryland; 5 University of California, Los Angeles; 6 Beth Israel Medical Center, New York; 7 St. Luke’s-Roosevelt Medical Center, New York.

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Authors and Affiliations

  1. Department of Psychiatry, Health Psychology Program, University of California, San Francisco, 3333 California St., Suite 465, Box 0848, 94143-0848, San Francisco, CA, USA

    Adam W. Carrico

  2. Center for AIDS Prevention Studies, University of California, San Francisco, USA

    Margaret A. Chesney, Mallory O. Johnson, Stephen F. Morin & Torsten B. Neilands

  3. New York State Psychiatric Institute, Columbia University, New York, USA

    Robert H. Remien

  4. University of California, Los Angeles, USA

    Mary Jane Rotheram-Borus & F. Lennie Wong

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  1. Adam W. Carrico
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Correspondence to Adam W. Carrico.

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Carrico, A.W., Chesney, M.A., Johnson, M.O. et al. Randomized Controlled Trial of a Cognitive-Behavioral Intervention for HIV-Positive Persons: An Investigation of Treatment Effects on Psychosocial Adjustment. AIDS Behav 13, 555–563 (2009). https://doi.org/10.1007/s10461-008-9429-6

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