In addition to its impact on HIV disease progression and transmission risk, ART nonadherence has important implications for the emergence of treatment-resistant strains of the virus (Bangsberg, 2008 and Wainberg and Friedland, 1998). Although high levels of adherence can be achieved in both resource-rich

and resource-limited environments, long-term adherence is more challenging (Nachega et al., 2011). Because the presence of depressive symptoms is a major barrier to optimal ART adherence (Gonzalez et al., 2011), the simultaneous treatment of depressive symptoms and ART nonadherence may minimize disease progression, decrease risk of transmission, and reduce likelihood of drug resistance. CBT has repeatedly been found to effectively treat depression in adult populations (Butler, Chapman, Forman, & Beck, 2006). Moreover, CBT for adherence and depression (CBT-AD) is an effective treatment for improving SCH 900776 molecular weight depressive

symptoms and medication adherence in the context of various chronic health conditions, including diabetes (Gonzalez et al., 2010 and Safren et al., in press) and HIV infection (Safren et al., 2009, Safren et al., 2012 and Simoni et al., 2013). The primary aim of the current paper and accompanying video components is to provide an illustration of the CBT-AD approach, with an emphasis on highlighting the components that differ substantially from traditional CBT for depression. Video components show role-play demonstrations by doctoral-level therapists Kinase Inhibitor Library purchase who received CBT-based training and supervision as part of our intervention studies. Abbreviated descriptions

PD184352 (CI-1040) of the overall treatment are provided and further detail can be found in our published treatment manual (Safren, Gonzalez, & Soroudi, 2008b) and client workbook (Safren, Gonzalez, & Soroudi, 2008a). Role-play examples provide demonstrations of commonly employed intervention techniques, and are based on typical client presentations. For all demonstrations, specifics were changed sufficiently so as to preserve patient anonymity and patient roles are played by therapists from our program. CBT-AD for HIV-infected adults follows a modular approach that addresses both depression and ART adherence in each session. Self-report questionnaires assess symptoms of depression and ART adherence prior to each session in order to track symptom change over time and tailor intervention content and skills delivery to the specific needs of the patient. Each module corresponds to a set of skills that addresses the cognitive and behavioral patterns that are commonly experienced by adults with co-occurring depression and HIV infection. The treatment begins with a CBT-oriented intervention to address adherence, called Life-Steps (Safren, Otto, & Worth, 1999), which provides psychoeducation about ART adherence and identifies barriers to optimal adherence.