Home-Based Telepsychiatry and in-Home CBT for Management of Major Depression in HIV-Positive Adults 50 Years and Older: A Proof-of-Concept Study

Background: HIV clinicians are increasingly confronting mild major depression and dysthymic disorder in their older patients. Despite rapid advances in technologybased interventions in the medical field, particularly in psychiatric treatment, the utilization of this resource in mental health services delivery research in the context of HIV disease has been limited. Home-based telemedicine (HBT) – which in this article mainly refers to telepsychiatry – combined with in-home cognitive behavioral therapy (CBT) may serve as a promising clinical strategy through which a broader patient population can be treated.

Objective: The current study aimed to assess: (1) change in psychiatric symptoms, (2) change in perception towards the acceptability of telemedicine, and (3) the viability of using a combined treatment of in-home CBT and HBT.

Methods: Subjects engaged in 6-12 weeks of weekly in-home CBT paired with monthly follow-up home-based telepsychiatry (HBT) sessions for the management of mild to moderate depression in older persons living with HIV (PLWH).

Results: 3 subjects completed the current study. Subjects reported comfortability with receiving services by telemedicine, ability to talk freely, and perceived privacy of the sessions. Clinician feedback further supported the feasibility and acceptability of using this delivery of treatment.

Conclusion: Data gathered from the current study support the findings from the predecessor study. HBT coupled with in-home CBT may serve as a feasible method for the management and treatment of mild to moderate depression in PLWH aged 50+ in an urban setting. Larger clinical trials focused on older PLWH using a similar treatment regimen will help provide more insight into viable healthcare models for this growing population.


James A Bourgeois

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