Directly Observed Antidepressant Medication Treatment and HIV Outcomes Among Homeless and Marginally Housed HIV-Positive Adults

A Randomized Controlled Trial

This study examines whether directly observed fluoxetine treatment may be an effective strategy to reduce depression symptom severity and improve HIV treatment outcomes.

In a non-blinded, randomized controlled trial, 66 participants were assigned to the intervention arm, and 71 were included in the referral (control) arm. The study recruitment period lasted over five years and was conducted in San Francisco. Participants in the intervention arm were directly observed taking once-weekly fluoxetine for 24 weeks, followed by a self-administration period of 12 weeks. Participants in the referral arm were advised to seek treatment at a nearby, accessible mental health clinic.

Key Findings:

  • Directly observed treatment with fluoxetine improved depression symptom severity (measured using the 17-item Hamilton Depression Rating Scale score).
  • There were no statistically significant effects of the intervention on antiretroviral therapy, the secondary outcome measure of the study.

In a population of homeless and marginally housed HIV-positive adults, medication adherence and attending scheduled appointments can be further complicated by depression. This study specifically targeted such a population and demonstrated that directly observed fluoxetine treatment may be an effective depression treatment strategy.

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