Telephone-Delivered Interventions for People Living with HIV/AIDS: Guest Editorial

Abstract

Telephone-delivered behavioral support interventionsfor persons living with HIV are the focus of theHeckman and Carlson (2006) and Stein et al. (2006)studies published in this issue. The specific interven-tions tested and the decision to offer them bytelephone were stimulated by the prevalence of mentalhealth stressors that compromise adjustment andeffective coping in this population as well as commonlyexperienced barriers to receiving care. As noted intheir reviews of the literature, there is considerablealthough mixed support for the efficacy of telephone-based interventions with a number of psychologicaland health problems in various populations.The 229 participants in the Heckman and Carlsonstudy, being served by AIDS service organizations atthe time of study enrollment and living in rural areas,were randomly assigned to usual care, or one of two 8-session telephone group interventions: an InformationSupport Group (i.e., didactic content on health topicspertinent to HIV) and a Coping Improvement Group(i.e., learning strategies of stressor appraisal andenhancing coping skills). Although 71% scored atbaseline in the moderate to severe range on the BeckDepression Inventory (BDI), at follow-up no treat-ment condition produced reductions in depression orother psychological symptoms under study. Some post-treatment improvement of limited duration (moresupport from friends, fewer barriers to services) wasreported by Information Support Group participants.The 177 participants in the study conducted by Steinand his colleagues had comparable BDI baselineratings to those in the Heckman and Carlson trial(i.e., mean score in the moderate to severe range.)Participants were randomized to a psycho-educationalcounseling approach called Family Intervention: Tele-phone Tracking (FITT, up to 12 calls with an inter-ventionist over 6 months) or assessment only.Structured to include a Resource Guide, FITT focusedon education, problem appraisal, and referral forservices related to mood and family functioning. Whenparticipants enrolled along with their informal care-giver, they each received the same content deliveredseparately. Overall, depression scores were lower atfollow-up, but contrary to expectation, there were nodifferences in depressive symptom reduction betweenconditions.In summary, the investigators of both studies reportnull findings and in their discussions they recognizethat the process of testing innovative behavioralinterventions is iterative, with each study’s findingsoften giving rise to questions to be addressed by thenext. Looking ahead, Heckman and Carlson recom-mend enhanced training of group facilitators (e.g.,skills with telephone delivery, familiarity with contex-tual issues for HIV positive individuals who live inrural environments), longer treatment, 24-h access forparticipants to information and support, and proactiveattrition reduction strategies. Stein and his colleaguesalso wonder if their intervention was sufficientlypotent. They additionally question whether an ade-quately powered trial might reveal the experimentalcondition’s efficacy with certain subgroups.On its face, delivering counseling by telephone iscompelling. Potential benefits include cost savings,