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A Practical Approach to Addressing Mental Health in HIV An Online and Mobile Mini-Curriculum

Richard Elion, MD; Glenn Jordan Treisman, MD, PhD

This activity is jointly provided by Global Education Group and Integritas Communications.

 

This activity is supported by an educational grant from Gilead Sciences, Inc.

 

Faculty

Richard Elion, MD
Clinical Professor of Medicine
George Washington University, School of Medicine
Washington, District of Columbia

Glenn Jordan Treisman, MD, PhD
Director, AIDS Psychiatry Service
Professor of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine
Baltimore, Maryland

Target Audience

The educational design of this activity addresses the needs of physicians, physician assistants, and nurse practitioners involved in the treatment of patients with human immunodeficiency virus (HIV).

Educational Objective

After completing this activity, the participant should be better able to:

  • Implement screening and appropriate treatment strategies for depression in patients with HIV to optimize adherence and retention in care

Statement of Need/Program Overview

Depression is common in patients with HIV and can result in nonadherence and reduced levels of viral suppression.1,2 Clinicians should be aware of the relationship between stigma, social isolation, and depression, which may be particularly severe in people of color and men who have sex with men (MSM).3 Pharmacologic treatment of depression can greatly improve quality of life, adherence, and, therefore, viral suppression. Depression is not the only factor that may affect a patient’s mental health. Substance use disorder, or even recreational substance use, which is not uncommon in the HIV population, like depression, may result in reduced adherence or viral suppression.4,5 Patients should be screened in a nonjudgmental manner so that they may be referred to addiction programs or mental health professionals.6 Through a peer-to-peer discussion, Dr. Elion and Dr. Treisman provide straightforward strategies that an HIV specialist can use to screen for and address both mental health disorders and substance use in patients with HIV.

References

  1. Gokhale RH, Weiser J, Sullivan PS, Luo Q, Shu F, Bradley H. Depression prevalence, antidepressant treatment status and association with sustained HIV in care in the United States, 2009–2014.. AIDS Behav. 2019;23(12):3452-3459.
  2. Mills JC, Harman JS, Cook RL, et al. Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression.  AIDS. 2017;31(18):2515-2524.
  3. Rhodes SD, Hergenrather KC, Vissman AT, et al. Boys must be men, and men must have sex with men: a qualitative CBPR study to explore sexual risk among African American, Latino, and white gay men and MSM.. Am J Mens Health. 2011;5(2):140-151.
  4. Bositis CM, St. Louis J. HIV and substance use disorder: role of the HIV physician. Infect Dis Clin North Am. 2019;33(3):835-855.
  5. Hartzler B, Dombrowski JC, Williams JR, et al. Influence of substance use disorders on 2-year HIV care retention in the United States.. AIDS Behav. 2018;22(3):742-751.
  6. US Department of Health and Human Services. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. 2019; https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/whats-new-guidelines Accessed September 14, 2020.

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications.  Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global designates this enduring activity for a maximum of 0.50 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 75% or better on the posttest and complete the program evaluation.

Fee Information& Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Richard Elion, MD: Consultant/Independent Contractor, Speakers Bureau: Gilead Sciences, Inc.; Grant/Research Support, Honoraria: Gilead Sciences, Inc., ViiV Healthcare Limited; Other: Work with Trio Health, who gets grants from Gilead Sciences, Inc. and ViiV Healthcare Limited

Glenn Jordan Treisman, MD, PhD: Nothing to disclose

The following planners and managers reported no financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Lindsay Borvansky, Andrea Funk, Liddy Knight, Ashley Cann, Gena Dolson, MS, Stacey JP Ullman, MHS, Jim Kappler, PhD

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global and Integritas Communications do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Click "Begin Activity" to acknowledge that you have reviewed the preamble information for this activity.

Begin Activity

credit amount 0.50

credit type CME

release 11/12/2020

expiration 11/12/2021


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Connection ID: db (CDbConnection)

Driver mysql
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Uptime 14w 1d 5h 49m 17s
Threads 1
Questions 40786824
Slow queries 13
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Flush tables 1
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Query Count Total (s) Avg. (s) Min. (s) Max. (s)
UPDATE activities SET archived=1 WHERE finishDate<now();
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1 0.003100 0.003100 0.003100 0.003100
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3 0.002503 0.000834 0.000251 0.001853
SELECT * FROM `activities` `t` WHERE `t`.`id`=218 LIMIT 1
5 0.001758 0.000352 0.000274 0.000590
SHOW COLUMNS FROM `activities`
1 0.001715 0.001715 0.001715 0.001715
SHOW COLUMNS FROM `events`
1 0.001478 0.001478 0.001478 0.001478
SHOW COLUMNS FROM `users`
1 0.001225 0.001225 0.001225 0.001225
SHOW COLUMNS FROM `resources`
1 0.001151 0.001151 0.001151 0.001151
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001116 0.000558 0.000266 0.000850
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
3 0.001083 0.000361 0.000249 0.000576
SHOW COLUMNS FROM `interactions`
1 0.001032 0.001032 0.001032 0.001032
SHOW COLUMNS FROM `view_log`
1 0.001021 0.001021 0.001021 0.001021
SHOW COLUMNS FROM `user_activitiesstatus`
1 0.001012 0.001012 0.001012 0.001012
SHOW COLUMNS FROM `questionnaires`
1 0.000989 0.000989 0.000989 0.000989
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000973 0.000486 0.000483 0.000490
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=218)
1 0.000637 0.000637 0.000637 0.000637
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
1 0.000531 0.000531 0.000531 0.000531
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=218) GROUP BY `activity_id`
1 0.000431 0.000431 0.000431 0.000431
SHOW CREATE TABLE `activities`
1 0.000351 0.000351 0.000351 0.000351
SHOW CREATE TABLE `events`
1 0.000343 0.000343 0.000343 0.000343
SHOW CREATE TABLE `users`
1 0.000329 0.000329 0.000329 0.000329
SHOW CREATE TABLE `view_log`
1 0.000308 0.000308 0.000308 0.000308
SHOW CREATE TABLE `questionnaires`
1 0.000304 0.000304 0.000304 0.000304
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
1 0.000297 0.000297 0.000297 0.000297
SHOW CREATE TABLE `user_activitiesstatus`
1 0.000281 0.000281 0.000281 0.000281
SHOW CREATE TABLE `resources`
1 0.000277 0.000277 0.000277 0.000277
SHOW CREATE TABLE `interactions`
1 0.000272 0.000272 0.000272 0.000272
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000850
1
SHOW COLUMNS FROM `activities`
0.001715
2
SHOW CREATE TABLE `activities`
0.000351
3
SHOW COLUMNS FROM `users`
0.001225
4
SHOW CREATE TABLE `users`
0.000329
5
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000483
6
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003815
7
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000490
8
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491781
0.003100
9
SELECT * FROM `activities` `t` WHERE `t`.`id`=218 LIMIT 1
0.000590
10
SHOW COLUMNS FROM `events`
0.001478
11
SHOW CREATE TABLE `events`
0.000343
12
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.001853
13
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000266
14
SELECT * FROM `activities` `t` WHERE `t`.`id`=218 LIMIT 1
0.000293
15
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000399
16
SELECT * FROM `activities` `t` WHERE `t`.`id`=218 LIMIT 1
0.000313
17
SHOW COLUMNS FROM `user_activitiesstatus`
0.001012
18
SHOW CREATE TABLE `user_activitiesstatus`
0.000281
19
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
0.000576
20
UPDATE activities SET archived=1 WHERE finishDate<now();
0.006592
21
SHOW COLUMNS FROM `view_log`
0.001021
22
SHOW CREATE TABLE `view_log`
0.000308
23
INSERT INTO `view_log` (`source`, `unique_id`, `resource_id`, `type`) VALUES (:yp0, :yp1, :yp2, :yp3)
0.003288
24
SHOW COLUMNS FROM `interactions`
0.001032
25
SHOW CREATE TABLE `interactions`
0.000272
26
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=218)
0.000637
27
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=218) GROUP BY `activity_id`
0.000431
28
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000251
29
SELECT * FROM `activities` `t` WHERE `t`.`id`=218 LIMIT 1
0.000288
30
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
0.000258
31
SELECT * FROM `activities` `t` WHERE `t`.`id`=218 LIMIT 1
0.000274
32
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
0.000249
33
SHOW COLUMNS FROM `questionnaires`
0.000989
34
SHOW CREATE TABLE `questionnaires`
0.000304
35
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
0.000531
36
SHOW COLUMNS FROM `resources`
0.001151
37
SHOW CREATE TABLE `resources`
0.000277
38
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
0.000297
Log Messages
Message (details) Level Category Time