# Implementation of collaborative care for depression in VA HIV clinics: Translating Initiatives for Depression into Effective Solutions (HITIDES)

> **NIH VA I01** · CENTRAL ARKANSAS VETERANS HLTHCARE SYS · 2021 · —

## Abstract

Project Summary / Abstract
Background: HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) is a collaborative
care intervention that adapts the primary care collaborative care model for depression treatment to HIV clinics.
In a randomized controlled trial, HITIDES significantly improved depression symptoms for Veterans Living with
HIV (VLWH) and delivered cost savings. However, no VHA HIV clinics have implemented HITIDES. The goal
of this study is to support broad implementation of the HITIDES intervention by testing two appropriate
implementation strategies: a clinical champion from each site who, with the help of a learning collaborative of
peers, will work with local clinicians and leadership to implement the HITIDES intervention at their site with and
without the assistance of external facilitation from an implementation expert.
Significance/Impact: Preliminary work has been completed to identify implementation strategies acceptable to
VLWH and HIV care providers; however, the relative effectiveness and cost of these implementation strategies
is unknown. While the HITIDES depression care team (DCT) is housed off-site and can deliver services
consistently with high quality and fidelity, the ability of the DCT to interface and engage with HIV care providers
at sites is unknown. Additionally, the mediating effect of site-level implementation outcomes such as reach and
adoption on effectiveness of the intervention is unknown. Because the DCT can provide services to multiple
HIV clinics, a small-scale rollout of the intervention is needed before considering a national roll out.
Innovation: This study employs an innovative hybrid study design to concurrently examine implementation and
effectiveness outcomes. The use of implementation success as a mediating factor for intervention
effectiveness is also novel. The relative ability of implementation activities to impact care for vulnerable
populations is an area of research where little is known. VHA HIV clinics are an ideal test case for examining
these questions because VLWH are a group where racial minority, low income, sexual minority Veterans are
disproportionately represented.
Specific Aims: 1) Determine, through a cluster-randomized controlled trial among VHA HIV clinics, the effect of
adding external facilitation to an implementation strategy consisting of a site-level clinical champion and
learning collaborative. 2) Determine the impact of HITIDES on changes in depression and suicidal ideation
among HIV-positive Veterans receiving the intervention. 3) Estimate the budget impact of HITIDES
implementation strategies by calculating the costs of each strategy.
Methodology: The use of a hybrid type-3 effectiveness-implementation trial to examine the interaction of
implementation and intervention effectiveness is an innovative methodology ideal for situations where the lack
of robust evidence of effectiveness is coupled with a cost-saving intervention. This hybrid trial wi...

## Key facts

- **NIH application ID:** 9837042
- **Project number:** 1I01HX002759-01A1
- **Recipient organization:** CENTRAL ARKANSAS VETERANS HLTHCARE SYS
- **Principal Investigator:** Jacob T Painter
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2023-08-01 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9837042

## Citation

> US National Institutes of Health, RePORTER application 9837042, Implementation of collaborative care for depression in VA HIV clinics: Translating Initiatives for Depression into Effective Solutions (HITIDES) (1I01HX002759-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9837042. Licensed CC0.

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