MODELING DEPRESSION TREATMENT STRATEGIES FOR HUMAN IMMUNODEFICIENCY VIRUS INFECTED (HIV+) PATIENTS USING AGENT-BASED MODELING
Candidate for the Lee B. Lusted Student Prize Competition
Purpose: HIV infected individuals with untreated or undertreated depression are more likely to have low rates of adherence to antiretroviral treatment, become unemployed/disabled, and die. Thirty to eighty percent of HIV infected patients present with clinically depressive symptoms. However, the availability and quality of depression screening and treatment options vary across clinics. Our study examines how depression treatment strategies for HIV infected patients affect HIV transmission, HIV/AIDS treatment outcomes, and remission of depression.
Method: We utilized Agent-Based Modeling to represent the epidemiology of HIV and the structure of HIV-related health services for both depression and HIV disease. We created a cohort of 100,000 people with demographics, HIV status and HIV risk behaviors representative of the US population. As a base case, 75% of newly diagnosed HIV infected are linked to HIV care, a mean of 50% are depressed, and 40% of the depressed receive depression treatment with a 28% success rate. We simulated agents' HIV related actions and interactions demonstrating how HIV-infected individuals transmit the disease through HIV risky behaviors. The model tracks HIV-related health service utilization for treatment and depression. We developed six scenarios with different rates of availability (40% to 75%) and success of depression treatment (28% to 63%) and assessed the overall effects of health service utilizations on HIV transmission, HIV/AIDS treatment outcomes, and remission of depression.
Result: Compared to the base case, a scenario with 100% linkage, 75% receipt of treatment and a 63% success rate would prevent, in the US population over a 50 year period, 54,644 individuals from becoming HIV infected. Additionally, 226,066 more newly diagnosed HIV+ patients would be linked to care, 72,036 more depressed HIV+ would be offered depression treatment, 91,642 more would be in remission from depression and 193,502 HIV+ patients would be adherent to treatment.
Conclusion: The number of HIV-infected persons in the population can be appreciably reduced by improving the effectiveness of depression treatment and offering treatment to a broader segment of newly diagnosed cases.
Figure 1. Comparisons between current strategies and optimal strategies for HIV/AIDS and depression treatments