Implementation of Collaborative Care for Depression in VA HIV Clinics

Summary

HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) is a team-based service to manage depression in Veterans Living with HIV (VLWH). This service is more effective for managing depression than the care VLWH usually receive and saves resources. HITIDES is also liked by HIV care providers and VLWH. Despite this, no VA clinics currently offer this service. This study examines two approaches to engage clinics with HITIDES, the resulting effects on VLWH, and the costs of these approaches. The first approach includes recruiting an HIV care provider at the site to help connect with the service and a network of providers to support this person. The second approach uses an additional external expert to facilitate these connections. Understanding how to connect Veterans to the HITIDES service will allow VA to improve depression care for VLWH and save VA resources.

Conditions

• HIV
• Depression

Interventions

OTHER

Local clinical champion

A clinical champion is a local provider who serves as a liaison between local clinics and local or regional leadership or national program offices (e.g., HHRC) and advocates for the HITIDES intervention with their local peers. A clinical champion can provide ongoing promotion of and education about HITIDES and remind care providers of its presence and value either formally (e.g., presentations at staff meetings) or informally (e.g., individual conversations about HITIDES benefits). Clinical champions can also engage middle managers or local leadership to buy in to and support intervention uptake. Clinical champions may also work with Veterans in quality improvement efforts to garner their ideas for how to outreach to other Veteran patients, plan quality improvement cycles, or consult in an advisory capacity. Potential champions will be approached about participation after consultation with site HIV care providers and HHRC.

OTHER

Learning collaborative

Learning Collaboratives are groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation (HITIDES). There are several approaches to this in the literature including peer consultation networks, online communities of practice, quality circles, and learning collaboratives. Groups will meet virtually using a wide variety of media. Participation will be monitored by research staff and recorded by participants in a time-tracking log but not controlled. The learning collaboratives will be comprised of a group of site clinical champions, HIV care providers, and other VHA HIV care representatives, potentially including Veterans who are engaged in implementation activities, to foster a learning environment to improve the implementation of HITIDES through consultation.

OTHER

External facilitation

. External facilitation will be provided by a trained external facilitator who is given the HITIDES Operations Guide and Consumer Voice tools for Veteran engagement in quality improvement. Facilitation is a process to enable sites to increase uptake of HITIDES through supportive relationships and strategies to navigate the implementation process. Virtual external facilitation is a recognized modality of facilitation delivery in VHA. The external facilitator will work with the clinical champion, site personnel, and Veterans-not conducting research activities but engaging in quality improvement processes with these individuals. The addition of a facilitator allows problem identification and problem-solving, using processes based on supportive relationships.

Sponsors & Collaborators

• VA Office of Research and Development

  lead FED

Principal Investigators

• Jacob T Painter, PhD PharmD · Central Arkansas Veterans Healthcare System , Little Rock, AR

• Eva N Woodward, PhD MA BS · Central Arkansas Veterans Healthcare System , Little Rock, AR

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-08-01

Primary Completion

2026-07-31

Completion

2027-07-31

Countries

• United States

Study Locations