A Randomized Controlled Trial of Telephone-Administered
Interpersonal Psychotherapy (IPT) for Depressed Rural Persons
Living with HIV/AIDS
Amanda Kocoloski, OMS IV; Timothy Heckman, Ph.D.; Bernadette Heckman, Ph.D.;
Timothy Anderson, Ph.D.; Victor Heh, Ph.D.; Mark Sutton, LSW
OU-COM Center for Telemedicine Research and Interventions, Athens, OH.
Abstract
Methods
Introduction: HIV-infected rural persons experience elevated rates
of depression, suicidal ideation, stigma/discrimination, lack access
to contemporary medical and mental health services, and have
difficulty adhering consistently to regimens of antiretroviral
therapy (ART).1,2,3 Cost-effective and easily accessible mental
health services are urgently needed for HIV-infected rural persons.
Background: Project Alliance is a randomized controlled trial of the
effectiveness of telephone-administered IPT in reducing
depressive symptoms in depressed HIV-infected rural persons
compared to a standard of care (SOC) control condition.
Methodology: Participants’ depressive symptoms, interpersonal
problems, social supports, and adherence to ART are being
assessed at pre- and post-intervention and 4- and 8-month followup. The project will enroll 180 participants; 90 will receive 9
sessions of telephone IPT and 90 SOC controls will receive
psychosocial services available in their home communities. To
date, 40 eligible participants have been identified. Demographic
information on these 40 participants is provided in Figures 2a-c.
Conclusion: Preliminary intervention-outcome analyses will report
on short-term changes associated with the IPT intervention.
 Participants are being recruited from 6 types of counties
designated as nonmetropolitan by the U.S. Department of
Agriculture
Introduction
Data
 Methods of recruitment include contacting AIDS service
organizations (ASOs) throughout the nation and information
disseminated by the Rural Center for AIDS Prevention (RCAP)
at Indiana University
 Upon receipt of the signed consent form, potential
participants are screened for eligibility
Table 1. Inclusion Criteria
Rural
status†
Age ≥18
HIV/AIDS
MDD*, partial
remission of MDD,
or dysthymia
Rural residence for Informed consent
next 12 months
Discussion
55- Completed eligibility
interviews
 If telephone-administered IPT is shown to be effective, the
research team will develop a manual that describes how to
provide IPT over the phone and disseminate it free of charge to
organizations and individuals working with HIV+ depressed
individuals living in rural communities
40- Eligible and enrolled
References
Figure 1. Participant Recruitment and Screening
554- Completed initial
screening
303- Satisfied rural criterion
1.
225- Informed consents
returned
10- Baselines completed
2.
Figures 2a-c. Demographics of Individuals
Currently Eligible and Enrolled (n= 40)
2a. Gender
Males
*MDD: major depressive disorder
4.
Females
5.
38%
† U.S. Department of Agriculture Rural-Urban Continuum Code of 4 (with
population <70,000), 5, 6, 7, 8, or 9.
Table 2. Exclusion Criteria
Serious cognitive or neuropsychiatric impairment
62%
6.
2b. Sexuality
2c. Ethnicity
3% 3%
5%
 Compared to urban counterparts, rural HIV+ individuals are more
likely to be diagnosed with depression, less likely to visit mental
health professionals, and have significantly shorter survival
periods1,2,4
 Interpersonal psychotherapy (IPT) is ideal for depressed
individuals with HIV/AIDS due to its short duration and emphasis
on current interpersonal relationships5
 Face-to-face IPT has been shown to be as efficacious as
psychotherapy and antidepressant medication in reducing
depression6
 Previous telemedicine in the HIV/AIDS population has focused on
reducing risky sexual behaviors, improving treatment adherence,
and enhancing quality of life7,8,9
 Therapeutic alliance refers to the positive bond between the
client and therapist, a consensus on the goals of therapy, and the
collaborative engagement in the tasks of therapy10; it is currently
unclear if alliance can be established and maintained over the
telephone
 Despite several limitations, a pilot RCT of telephone-administered
IPT did show reduction in depressive symptoms in HIV-infected
rural individuals11
3.
7.
22%
40%
 Eligible individuals are mailed a baseline survey to assess
8.
42%
 Depressive symptoms according to the Beck Depression
Inventory (primary outcome)
 Interpersonal problems (Inventory of Personal Problems)
 Social supports (Provision of Social Relations)
 Adherence to ART (ART Treatment Adherence)
 Participants are randomized to SOC or IPT + SOC
 IPT + SOC receive 9 weekly hour-long sessions of telephoneadministered IPT from trained therapist
 On a weekly basis, all participants complete the SelfAssessing Depression Scale (SADS) using the interactive voice
response (IVR) system
 IPT + SOC participants also complete the Working Alliance
Inventory to assess alliance
 Surveys are being completed by all participants postintervention and at 4 and 8 month follow-up intervals
 Preliminary intervention-outcome analyses will report on
short-term changes associated with the IPT intervention
3%
69%
13%
Gay
Bisexual
Heterosexual
No Response
White/Non-Hispanic
Hispanic/Latino
African American/Non-Hispanic
African American/Hispanic
Other
Discussion
9.
10.
Telephone-administered mental health interventions for
depressed rural individuals are appealing to help overcome
geographical barriers, maximize confidentiality, and to create
emotional support systems12
11.
Telepsychiatry is effective in treating depressive disorders13
13.
Face-to-face IPT is as efficacious as antidepressant medication
and psychotherapy in reducing depression in HIV+ individuals6
This RCT will fill gaps in the literature regarding the effectiveness
of telephone-administered IPT on HIV+ rural individuals’ depressive
symptoms, interpersonal problems, social supports, and adherence
to ART
12.
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Acknowledgements
 We would like to thank the NIH for their generous funding that
made this study possible