HiveSMARTESTNCT05278572
e-SMART/EST HIV Telehealth Intervention
A study testing Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST) in people with Hiv and Depression, run by Albert Einstein College of Medicine at 1 site in United States.
Trial summary
The goal of this project is to adapt an evidence-based, enhanced cognitive-behavioral stress management intervention (CSBM+) to target depression among older HIV-positive women in the Bronx, New York. Read more about this study
- Who is it for?
- Ages 55 to 99 years, women only
- Conditions the study is for
- Hiv, Depression
- What is being tested?
- Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 10 participants
- Where
- 1 siteUnited States
- Study dates
- 25 Jan 2023to 5 Apr 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 55 to 99 years
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- HIV-positive
- Age 55+
- Teletherapy access
- Depression in last 12 months.
- Fluent in English
Who cannot join
- HIV-negative or HIV-unknown
- Younger than 55 years old
- Lack of depression in last 12 months
- Non-fluent in English
- Opioid use disorder in last 12 months
- Psychotic disorder in last 12 months.
Trial locations and contacts
1 site in 1 country.
United States1 site
Albert Einstein College of Medicine - Department of Psychiatry and Behavioral Sciences
The Bronx, New York, 10461
About this study
Official title: e-SMART/EST Telehealth Intervention to Reduce Depression in Older Women With HIV
The goal of this project is to adapt an evidence-based, enhanced cognitive-behavioral stress management intervention (CSBM+) to target depression among older HIV-positive women in the Bronx, New York. The intervention, "Stress Management and Relaxation Training/Expressive Supportive Therapy" (SMART/EST), demonstrated effectiveness in numerous iterations over 15+ years, including trials with racially diverse HIV-positive women. To meet changing community needs including moving behavioral interventions to telehealth, we will pilot test e-SMART/EST, a teletherapy adaptation with peer support for HIV+ older women.
Read the detailed description
HIV-positive older women are a neglected, high-risk population for depression. Depression is the most common psychiatric comorbidity for people living with HIV (PLWH), with prevalence between 20-40% and up to 78% in some cohorts. It has associations with lower CD4 (cluster of differentiation 4 - a type of white blood cell) count, higher viral load, reduced medication adherence, and AIDS-related and all-cause mortality. Among older people living with HIV/AIDS (PLWHA), women are more likely than men to be depressed.
Group teletherapy is an efficacious modality to target depression, including among PLWHA, with improved retention and acceptability. To harness these innovations to improve outcomes for HIV+ older women, we will incorporate community feedback to refine and test an online adaption of SMART/EST, an empirically validated cognitive-behavioral stress management/expressive supportive therapy (CBSM+). SMART/EST is effective with HIV+ women and will likely be translated online given the proliferation of cognitive-behavioral therapy (CBT) teletherapy groups. Results will inform secondary prevention with a growing generation of HIV+ older women.
The original, in-person intervention is a 16-session, two-hour weekly group using CBSM+ to target depression, medication adherence, nutrition, physical activity, harm reduction, smoking, and safer sex. e-SMART/EST will be online, condensed to 8 weekly 1-hour sessions, and will target depression. The study has two phases. In Phase 1, we will obtain scientific, community and expert advice from 8 community peer, scientific, and clinical advisors to adapt existent protocols. In Phase 2, we will conduct a pragmatic single group pre-post trial with 10 participants recruited from Montefiore's Women's Interagency HIV Study (WIHS).
e-SMART/EST will be facilitated on MyChart by a Psychologist (PsyD) with prior experience developing the intervention, and co-facilitated by a community peer and Healthy Aging Specialist with 25+ years of experience in HIV programming. Participants will complete pre- and post-test surveys, as well as provide feedback about feasibility, adaptability, and recommendations to improve the intervention. Statistical analyses include paired-samples t-tests and adaptability/feasibility tests, as well as measures of fidelity.
- Conditions
- Hiv, Depression
- Being tested
- Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)
- Medical subject headings
- Acquired Immunodeficiency Syndrome, Depression
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)Behavioural
Cognitive-behavioral stress management/expressive supportive therapy (CBSM+) group targeting depression
| Study group | Role | What they receive |
|---|---|---|
| Group | Experimental | Intervention consists of a psychotherapy trial using cognitive-behavioral stress management/expressive supportive therapy to target depression among HIV-positive older women. Dosage: 8 sessions. Frequency: weekly. Duration: 8 weeks. Receives: Behavioral: Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Decrease in score from Baseline in Depression on 21-item Beck Depression Inventory (BDI) at Week 9
The Beck Depression Inventory (BDI) is a validated, self-report 21-item scale assessing depression. Response options range from 0-3 for each item. Item scores are summed, with sum scores ranging from 0-63. Higher scores indicate more depression (i.e., worse outcome). Scale scores from 1-10 indicate: These ups and downs are considered normal; 11-16: Mild mood disturbance; 17-20: Borderline clinical depression; 21-30: Moderate depression; 31-40: Severe depression; over 40: Extreme depression.
Measured: Baseline and Week 9
Decrease in score from Baseline in Anxiety on 21-item Beck Anxiety Inventory (BAI) at Week 9
The Beck Anxiety Inventory (BAI) is a validated, self-report 21-item scale assessing anxiety. Response options range from 0-3 for each item. Item scores are summed, with sum scores ranging from 0-63. Higher scores indicate more anxiety (i.e., worse outcome). Scale scores from 0-21 indicate: low anxiety; 22-35: moderate anxiety; 36 and above: potentially concerning levels of anxiety.
Measured: Baseline and Week 9
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Mar 2022
- Study start25 Jan 2023
- Primary completion5 Apr 2023
- Study completion5 Apr 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (9)Papers the sponsor has linked to this study.
- Other trials for HivStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- This clinical trial involves a single treatment arm, consisting of 10 women enrolled in a pilot group. The group will meet weekly for 8 weeks. The intervention consists of cognitive-behavioral stress management/expressive supportive therapy (CBSM+) targeting depression among older women with HIV. The group will be co-facilitated by a Psychologist and a Peer.
- Masking
- None (open label)
- Enrolment
- 10 participants (actual)
Sponsor and investigators
- Lead sponsor
- Albert Einstein College of Medicine
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Harris Goldstein, MD, Study director, Einstein-Rockefeller-City University of New York Center for AIDS Research
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05278572
- Sponsor's protocol ID
- 2021-13391
- Acronym
- eSMARTEST
- Status last verified
- Apr 2023
- First submitted
- 4 Mar 2022
- Last updated
- 6 Apr 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Waldron EM, Burnett-Zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, Tomaszewski E, Miller ES. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care. 2021 Jan-Dec;20:2325958220985665. doi: 10.1177/2325958220985665.
PubMed 33472517Jones DL, McPherson-Baker S, Lydston D, Camille J, Brondolo E, Tobin JN, Weiss SM. Efficacy of a group medication adherence intervention among HIV positive women: the SMART/EST Women's Project. AIDS Behav. 2007 Jan;11(1):79-86. doi: 10.1007/s10461-006-9165-8.
PubMed 17028992Weiss SM, Tobin JN, Antoni M, Ironson G, Ishii M, Vaughn A, Cassells A, Jones D, Schneiderman N, Brondolo E, Laperriere A, Lopez M, Villar-Loubet O, Camille J, Kumar M, Page JB; SMART/EST Women's Project Team*. Enhancing the health of women living with HIV: the SMART/EST Women's Project. Int J Womens Health. 2011 Feb 15;3:63-77. doi: 10.2147/IJWH.S5947.
PubMed 21445376Laperriere A, Ironson GH, Antoni MH, Pomm H, Jones D, Ishii M, Lydston D, Lawrence P, Grossman A, Brondolo E, Cassells A, Tobin JN, Schneiderman N, Weiss SM. Decreased depression up to one year following CBSM+ intervention in depressed women with AIDS: the smart/EST women's project. J Health Psychol. 2005 Mar;10(2):223-31. doi: 10.1177/1359105305049772.
PubMed 15723892Ironson G, Weiss S, Lydston D, Ishii M, Jones D, Asthana D, Tobin J, Lechner S, Laperriere A, Schneiderman N, Antoni M. The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women's Project. AIDS Care. 2005 Feb;17(2):222-36. doi: 10.1080/09540120512331326365.
PubMed 15763716Segal-Isaacson CJ, Tobin JN, Weiss SM, Brondolo E, Vaughn A, Wang C, Camille J, Gousse Y, Ishii M, Jones D, Laperriere A, Lydston D, Schneiderman N, Ironson G. Improving dietary habits in disadvantaged women with HIV/AIDS: the SMART/EST women's project. AIDS Behav. 2006 Nov;10(6):659-70. doi: 10.1007/s10461-006-9115-5. Epub 2006 Jun 1.
PubMed 16770694Weiss SM, Tobin JN, Lopez M, Simons H, Cook R, Jones DL. Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women's Program. Int J Behav Med. 2015 Jun;22(3):415-24. doi: 10.1007/s12529-014-9399-1.
PubMed 24623475Jones DL, Lopez M, Simons H, Diaz-Gloster M, Tobin JN, Weiss SM. Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program. Transl Behav Med. 2013 Dec;3(4):416-25. doi: 10.1007/s13142-013-0213-4.
PubMed 24294330Webel AR. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS Care. 2010 Sep;22(9):1029-40. doi: 10.1080/09540120903214389.
PubMed 20146111
Study at a glance
From the registry record, last updated by the sponsor on 6 Apr 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- e-SMART/EST Telehealth Intervention to Reduce Depression in Older Women With HIV
- ClinicalTrials.gov ID
- NCT05278572
- Acronym / sponsor ID
- eSMARTEST / 2021-13391
- Conditions
- Hiv, Depression
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 10 participants (actual)
- Lead sponsor
- Albert Einstein College of MedicineUniversity, hospital or other
- Study start
- 25 Jan 2023 (actual)
- Primary completion
- 5 Apr 2023 (actual)
- Study completion
- 5 Apr 2023 (actual)
- First posted
- 14 Mar 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this project is to adapt an evidence-based, enhanced cognitive-behavioral stress management intervention (CSBM+) to target depression among older HIV-positive women in the Bronx, New York. The intervention, "Stress Management and Relaxation Training/Expressive Supportive Therapy" (SMART/EST), demonstrated effectiveness in numerous iterations over 15+ years, including trials with racially diverse HIV-positive women. To meet changing community needs including moving behavioral interventions to telehealth, we will pilot test e-SMART/EST, a teletherapy adaptation with peer support for HIV+ older women.
Detailed description
HIV-positive older women are a neglected, high-risk population for depression. Depression is the most common psychiatric comorbidity for people living with HIV (PLWH), with prevalence between 20-40% and up to 78% in some cohorts. It has associations with lower CD4 (cluster of differentiation 4 - a type of white blood cell) count, higher viral load, reduced medication adherence, and AIDS-related and all-cause mortality. Among older people living with HIV/AIDS (PLWHA), women are more likely than men to be depressed.
Group teletherapy is an efficacious modality to target depression, including among PLWHA, with improved retention and acceptability. To harness these innovations to improve outcomes for HIV+ older women, we will incorporate community feedback to refine and test an online adaption of SMART/EST, an empirically validated cognitive-behavioral stress management/expressive supportive therapy (CBSM+). SMART/EST is effective with HIV+ women and will likely be translated online given the proliferation of cognitive-behavioral therapy (CBT) teletherapy groups. Results will inform secondary prevention with a growing generation of HIV+ older women.
The original, in-person intervention is a 16-session, two-hour weekly group using CBSM+ to target depression, medication adherence, nutrition, physical activity, harm reduction, smoking, and safer sex. e-SMART/EST will be online, condensed to 8 weekly 1-hour sessions, and will target depression. The study has two phases. In Phase 1, we will obtain scientific, community and expert advice from 8 community peer, scientific, and clinical advisors to adapt existent protocols. In Phase 2, we will conduct a pragmatic single group pre-post trial with 10 participants recruited from Montefiore's Women's Interagency HIV Study (WIHS).
e-SMART/EST will be facilitated on MyChart by a Psychologist (PsyD) with prior experience developing the intervention, and co-facilitated by a community peer and Healthy Aging Specialist with 25+ years of experience in HIV programming. Participants will complete pre- and post-test surveys, as well as provide feedback about feasibility, adaptability, and recommendations to improve the intervention. Statistical analyses include paired-samples t-tests and adaptability/feasibility tests, as well as measures of fidelity.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- This clinical trial involves a single treatment arm, consisting of 10 women enrolled in a pilot group. The group will meet weekly for 8 weeks. The intervention consists of cognitive-behavioral stress management/expressive supportive therapy (CBSM+) targeting depression among older women with HIV. The group will be co-facilitated by a Psychologist and a Peer.
| Arm | Type | Receives |
|---|---|---|
| Group | Experimental | Behavioral: Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)Intervention consists of a psychotherapy trial using cognitive-behavioral stress management/expressive supportive therapy to target depression among HIV-positive older women. Dosage: 8 sessions. Frequency: weekly. Duration: 8 weeks. |
Who may qualify
- Ages
- 55 to 99 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- HIV-positive
- Age 55+
- Teletherapy access
- Depression in last 12 months.
- Fluent in English
Key exclusion criteria (6 listed)
- HIV-negative or HIV-unknown
- Younger than 55 years old
- Lack of depression in last 12 months
- Non-fluent in English
- Opioid use disorder in last 12 months
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST)Cognitive-behavioral stress management/expressive supportive therapy (CBSM+) group targeting depression | Behavioural | Group |
Primary outcome
Decrease in score from Baseline in Depression on 21-item Beck Depression Inventory (BDI) at Week 9
Time frame: Baseline and Week 9
The Beck Depression Inventory (BDI) is a validated, self-report 21-item scale assessing depression. Response options range from 0-3 for each item. Item scores are summed, with sum scores ranging from 0-63. Higher scores indicate more depression (i.e., worse outcome). Scale scores from 1-10 indicate: These ups and downs are considered normal; 11-16: Mild mood disturbance; 17-20: Borderline clinical depression; 21-30: Moderate depression; 31-40: Severe depression; over 40: Extreme depression.
Decrease in score from Baseline in Anxiety on 21-item Beck Anxiety Inventory (BAI) at Week 9
Time frame: Baseline and Week 9
The Beck Anxiety Inventory (BAI) is a validated, self-report 21-item scale assessing anxiety. Response options range from 0-3 for each item. Item scores are summed, with sum scores ranging from 0-63. Higher scores indicate more anxiety (i.e., worse outcome). Scale scores from 0-21 indicate: low anxiety; 22-35: moderate anxiety; 36 and above: potentially concerning levels of anxiety.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Apr 2023.
- Background: PubMed 33472517Waldron EM, Burnett-Zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, Tomaszewski E, Miller ES. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care. 2021 Jan-Dec;20:2325958220985665. doi: 10.1177/2325958220985665.
- Results publication: PubMed 17028992Jones DL, McPherson-Baker S, Lydston D, Camille J, Brondolo E, Tobin JN, Weiss SM. Efficacy of a group medication adherence intervention among HIV positive women: the SMART/EST Women's Project. AIDS Behav. 2007 Jan;11(1):79-86. doi: 10.1007/s10461-006-9165-8.
- Results publication: PubMed 21445376Weiss SM, Tobin JN, Antoni M, Ironson G, Ishii M, Vaughn A, Cassells A, Jones D, Schneiderman N, Brondolo E, Laperriere A, Lopez M, Villar-Loubet O, Camille J, Kumar M, Page JB; SMART/EST Women's Project Team*. Enhancing the health of women living with HIV: the SMART/EST Women's Project. Int J Womens Health. 2011 Feb 15;3:63-77. doi: 10.2147/IJWH.S5947.
- Results publication: PubMed 15723892Laperriere A, Ironson GH, Antoni MH, Pomm H, Jones D, Ishii M, Lydston D, Lawrence P, Grossman A, Brondolo E, Cassells A, Tobin JN, Schneiderman N, Weiss SM. Decreased depression up to one year following CBSM+ intervention in depressed women with AIDS: the smart/EST women's project. J Health Psychol. 2005 Mar;10(2):223-31. doi: 10.1177/1359105305049772.
- Results publication: PubMed 15763716Ironson G, Weiss S, Lydston D, Ishii M, Jones D, Asthana D, Tobin J, Lechner S, Laperriere A, Schneiderman N, Antoni M. The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women's Project. AIDS Care. 2005 Feb;17(2):222-36. doi: 10.1080/09540120512331326365.
- Results publication: PubMed 16770694Segal-Isaacson CJ, Tobin JN, Weiss SM, Brondolo E, Vaughn A, Wang C, Camille J, Gousse Y, Ishii M, Jones D, Laperriere A, Lydston D, Schneiderman N, Ironson G. Improving dietary habits in disadvantaged women with HIV/AIDS: the SMART/EST women's project. AIDS Behav. 2006 Nov;10(6):659-70. doi: 10.1007/s10461-006-9115-5. Epub 2006 Jun 1.
- Results publication: PubMed 24623475Weiss SM, Tobin JN, Lopez M, Simons H, Cook R, Jones DL. Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women's Program. Int J Behav Med. 2015 Jun;22(3):415-24. doi: 10.1007/s12529-014-9399-1.
- Results publication: PubMed 24294330Jones DL, Lopez M, Simons H, Diaz-Gloster M, Tobin JN, Weiss SM. Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program. Transl Behav Med. 2013 Dec;3(4):416-25. doi: 10.1007/s13142-013-0213-4.
- Results publication: PubMed 20146111Webel AR. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS Care. 2010 Sep;22(9):1029-40. doi: 10.1080/09540120903214389.
- Clinical Directors Network website for previous iterations of the SMART/EST group for HIV-positive womenLink provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Harris Goldstein, MD study director
Einstein-Rockefeller-City University of New York Center for AIDS Research
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Stress Management and Relaxation Training/Expressive Supportive Therapy (SMART/EST) in people with Hiv and Depression, run by Albert Einstein College of Medicine at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Decrease in score from Baseline in Depression on 21-item Beck Depression Inventory (BDI) at Week 9 (time frame: Baseline and Week 9). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05278572, which also lists 9 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Apr 2023.