Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial

Steven A. Safren, Conall M. O'Cleirigh, Jacqueline R. Bullis, Michael W. Otto, Michael D. Stein, Mark H. Pollack

Research output: Contribution to journalArticlepeer-review

148 Scopus citations


Objective: Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment adherence. Injection drug users comprise a substantial portion of individuals with HIV in the United States and globally. The present study tested cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with HIV and depression in active substance abuse treatment for injection drug use. Method: This is a 2-arm, randomized controlled trial (N = 89) comparing CBT-AD with enhanced treatment as usual (ETAU). Analyses were conducted for two time-frames: (a) baseline to post-treatment and (b) post-treatment to follow-up at 3 and 6 months after intervention discontinuation. Results: At post-treatment, the CBT-AD condition showed significantly greater improvement than ETAU in MEMS (electronic pill cap) based adherence, γslope = 0.8873, t(86) = 2.38, p =.02; dGMA-raw = 0.64, and depression, assessed by blinded assessor: Mongomery-Asberg Depression Rating Scale, F(1, 79) = 6.52, p <.01, d = 0.55; clinical global impression, F(1, 79) = 14.77, p <.001, d = 0.85. After treatment discontinuation, depression gains were maintained, but adherence gains were not. Viral load did not differ across condition; however, the CBT-AD condition had significant improvements in CD4 cell counts over time compared with ETAU, γslope = 2.09, t(76) = 2.20, p =.03, dGMA-raw = 0.60. Conclusions: In patients managing multiple challenges including HIV, depression, substance dependence, and adherence, CBT-AD is a useful way to integrate treatment of depression with an adherence intervention. Continued adherence counseling is likely needed, however, to maintain or augment adherence gains in this population.

Original languageEnglish (US)
Pages (from-to)404-415
Number of pages12
JournalJournal of consulting and clinical psychology
Issue number3
StatePublished - Jun 2012
Externally publishedYes


  • adherence
  • antiretroviral therapy (ART)
  • depression
  • substance abuse

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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