5 - (SYM 63) Trajectories of Treatment Response in a Cognitive-behavioral Therapy Intervention for Depression and Adherence in PWH in South Africa

Background: People with HIV (PHW) are at greater risk of depression than the general population. Effective psychotherapies exist, but insight into the time-to-treatment-response and predictors of response may improve implementation in primary care.

Methods: We assessed depression treatment response among 80 participants in an RCT of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal adherence in primary care clinics in Cape Town, South Africa. Participants self-reported depressive symptoms (CES-D) at each therapy session. Clinicians assessed participants’ depression (HAM-D), along with various potential predictors of response (social support, distress aversion, behavioral avoidance, alcohol use, rumination, behavioral activation, substance use, and food insecurity), every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each.

Results: We identified two classes during the active treatment phase (CES-D), early responders (at session 2 and with continued trajectory of improvement) and non-responders, There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR=.74, 95%CI[0.56–0.90], p=.009), whereas social support was associated with increased likelihood of early response (aOR=2.24, 95%CI[1.07–5.46], p=.045).
Limitations: Self-reported depression during the treatment phase may have introduced placebo or social desirability effects, and caution is warranted against the use of these results to inform an optimal dosage of CBT-AD.

Conclusions: Most participants responded to CBT-AD early during treatment (89%) and had clinically significant improvements in depression by 4 months (80%). Distress aversion was a risk factor for late response, though social support was a protective factor. Future research is needed to assess the optimal dose of CBT-AD.