Valerie Toro- Rodríguez , Psy.D .

1. Session # 5 October 29, 20112:30 PM Psychological interventions based on the Integrated Primary Care Model and their impact on depression, treatment adherence and immunological status of people living with HIV/AIDS in the south of Puerto Rico Valerie Toro-Rodríguez, Psy.D. Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Faculty Disclosure I have not had any relevant financial relationships during the past 12 months.

3. Need/Practice Gap & Supporting Resources • Number of people diagnosed with HIV/AIDS is increasing (UNAIDS, 2010). • Higher life expectancy = more people dealing with multiple stressors associated with HIV/AIDS (Safren, Radomsky, Otto y Salomon, 2002). • HIV/AIDS affects the physical and the emotional health (Fulk, Kane, Phillips, Bopp y Hand, 2004). • More than 40,000 people diagnosed with HIV/AIDS in Puerto Rico (PR Health Department, 2011).

4. Objectives • Discuss some of the psychological implications associated with HIV/AIDS. • Describe some benefits associated with the integration of psychological interventions to the medical treatment for HIV/AIDS. • Discuss the results of the project. • Describe the implications that the results have for the psychology field.

5. Expected Outcome Understand that psychological interventions based on the integrated primary care model can be applied with HIV/AIDS patients and can influence positively their emotional and physical health.

6. Psychological Influences of HIV/AIDS

7. Psychological Influences of HIV/AIDS • HIV/AIDS patients deal with: • Anxiety symptoms • Depression • Stigma • Complicated therapy regimens • Loss of social support (WHO, 2008)

8. Depression • 23% of people living with HIV/AIDS in the US suffer from depression. (WHO, 2008) • The most prevalent mental health condition in the HIV/AIDS population. It influences: • Treatment adherence • Survival (Rabkin, 2008)

9. Depression • Depression has been associated with • Physical symptoms related to HIV/AIDS (Zorrilla, McKay, Luborsky y Schmidt, 1998) • Faster disease progression (Gore-Felton et al., 2006) • A weaker immune system and a higher mortality rate (Howland et al., 2000; Ickovics et al.; Leserman et al., 2002).

10. Stress • High levels of psychological stress affect: • Viral load (Ironson et al., 2005) • CD4 count (Ickovics et al., 2001; Leserman et al., 1999) • Some of the stressors related to antiretroviral treatment are: • Side effects • Multiple daily doses • Changes in the daily routine • Food restrictions (Kalichman, Ramachandran y Ostrow, 1998; Moosa y Jeenah, 2007)

11. Benefits of the Integration • Dodds et al. (2004) • Early detection on patients that need mental health services. • Primary care physicians develop better understanding of the emotional health and the importance of integrated management. • Better utilization of the mental health services. • Stress reduction. • Healthier behaviors.

12. Description of the Project

13. Purpose of the Study • Examine the impact of psychological interventions based on the integrated primary care model on the levels of depression, treatment adherence, and immunological functioning (viral load/CD4 count) on a sample of people living with HIV/AIDS in the south part of Puerto Rico.

14. Hypotheses • H1: A decrease on the level of depression will be observed after patient undergo psychological interventions, based on the integrated primary care model. • H2: An increase in the level of adherence will be observed after patient undergo psychological interventions, based on the integrated primary care model.

15. Hypotheses • H3: A decrease in the viral load will be observed after patient undergo psychological interventions, based on the integrated primary care model. • H4:An increase in the CD4 count will be observed after patient undergo psychological interventions, based on the integrated primary care model.

16. Method • Review of 182 records of patients living with HIV/AIDS that were treated by the Health Psychology Program of the Ponce School of Medicine during from June 2009 to October 2010. • The sample selection depended on the availability of the information on the records. • 57 records • 31.3% of people served during this period • Collection of the information necessary to test the research hypotheses. • Realization of the statistical analysis

17. Instruments • PHQ-9 • Depression screening that has been validated for primary care population (Spitzer, Kroenke, & Williams, 1999) • Administered at initial interview and after psychological treatment. • Immunological Status Record • Treatment adherence assessment instrument • Developed by Health Psychology team • Adherence = # pills prescribed / # of pills missed by the patient during the last month. • Contains information of the viral load and the CD4 count.

18. Instruments • Sociodemographic Data • Age • Gender • Method of infection • Time with the HIV/AIDS diagnosis • Reason for referral • Living place • Antiretroviral treatment

19. Sample Profile • Average age • 45 years • Method of infection • 56.1% Heterosexual sexual contact • 8.8% Homosexual sexual contact • 8.8% Intravenous drug use

20. Sample Profile

21. Sample Profile

22. Sample Profile

23. Results

24. Changes on the Levels of Depression

25. Adherence to Antiretroviral Treatment

26. Viral Load

27. CD4 Count

28. Implications • This findings suggest that the integrated primary care interventions could help to: • Decrease the levels of depression • Improve antiretroviral treatment adherence • Delay the virus progression In people living with HIV/AIDS .

29. Implications • Psychological treatment should be accessible and available for people living with HIV/AIDS in Puerto Rico. • It is recommended that psychologists integrate screenings for depression and treatment adherence in settings where HIV+ patients receive their medical treatment. • Psychologists at Puerto Rico that are working with the population should be trained in the integrated primary care model.

30. Lets Review… • What are some of the psychological implications of HIV/AIDS? • Which are some of the benefits of the integration of psychological interventions in the HIV/AIDS medical treatment? • How this information is important for the psychology field?

31. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!