Modeling Depression Treatment Strategies for Human Immunodeficiency Virus (HIV) Positive Patients

Abstract

This dissertation empirically examines the associations between depression and HIV-related outcomes, simulates both care and outcomes under different depression care strategies, and compares the cost effectiveness of various depression care strategies to the current care strategy. The empirical investigations reveal the negative associations between depression and HIV-related outcomes using two longitudinal patient-level databases. Furthermore, the patterns and outcomes of depression care are identified and simulated using agent-based modeling. Finally, simulated costs and effectiveness are used to evaluate different depression care strategies for reducing new HIV infections and improving quality of life. The current standard of care for depression among patients living with HIV can be characterized as low intensity in terms of screening and treatment; enhanced depression care strategies are proposed and evaluated to be cost-saving. Recommendations are offered to enhance depression care in HIV care settings