A randomized controlled trial of a web‐based psychological intervention for patients under treatment for chronic HIV infection

Abstract

Purpose of the studyOne of the most prevalent mental conditions in people with HIV is depression as uniquely characterized by low positive affect. This study examined the effect of a web‐based intervention (Avanti) on overall mood and depressive symptoms among patients with HIV infection.MethodsPatients treated with effective antiretroviral treatment were included in a two‐armed trial with substance abuse as an exclusion criterion and randomized to Avanti (n=36) or control (n=31). Patients were surveyed at baseline, as well as 1 and 3 months after the initiation of a 5‐week intervention period. Outcomes were Center for Epidemiological Studies‐Depression scale and the Positive and Negative Affect Schedule which was combined into an overall mood index. Changes within groups were tested by Wilcoxon matched pairs test and baseline differences between groups by chi‐square and Mann‐Whitney independent samples test.Summary of resultsBaseline scores for both groups were similar. However, patients in the intervention group had an improvement in median (M) overall mood from baseline (M=67.6) to 1 month (M=71, p=0.02) which was also maintained from 1 to 3 months (M=71.9). Moreover, these patients had a favorable reduction in negative affect from 1 (M=24) to 3 months (M=22, p=0.01) and a transient improvement in positive affect from baseline (M=31.7) to 1 month after intervention onset (M=35, p<0.01) which almost returned to baseline levels at month 3 (M=32, p=0.01). In contrast, no significant changes were observed within the control group, except for a reduction in negative affect from 1 (M=23) to 3 months (M=21.6, p=0.05). Notably, symptoms of depression at baseline were low in both the Avanti (M=13) and control (M=12) groups, possibly explaining why no further reduction in depression was observed from baseline to 3 months in either of the two groups.ConclusionsThe results of this study lend support to the promise of a web‐based psychological intervention among patients with HIV and its ability to improve overall mood with favorable intervention‐related changes in negative and positive affect. Avanti had no effect on depression but this was probably due to low initial symptoms of depression. The findings suggest that a prolonged web‐based intervention with regular contact could maintain the positive effects on mood seen in this study. If so, Avanti could potentially provide an easily accessible and cost‐effective adjunct to traditional psychotherapy.