Our Work

Improving the Health of South African Women with Traumatic Stress in HIV Care

Project Overview

PI: Kathleen J. Sikkema
Co-PI: John Joska (University of Cape Town)
Investigator: Melissa Watt
Funder: NIMH, R34, 2014-2017
Site: Cape Town, South Africa

HIV-infected women in South Africa report high rates of sexual trauma (both childhood and adulthood experiences). Women with sexual trauma histories have poorer mental health and may have unique challenges fully engaging with HIV care. Intervention research conducted in the U.S. demonstrates that an approach that reduces the use of avoidant coping strategies improves mental health and health behaviors among people living with HIV who have a history of sexual trauma. In South Africa, trauma treatment has not been well-integrated into the HIV care setting. Addressing the sequelae of sexual trauma among women within the context of HIV clinical care in South Africa can potentially improve the well-being of this patient population and also increase their engagement across the continuum of HIV treatment to reduce the forward transmission of HIV.

Project aims:
In this study, we will develop Improving AIDS Care after Trauma (ImpACT), an intervention based on theories of stress, coping, and evidence-based treatment for traumatic stress. This intervention will target women who are newly initiating ART, and will take place in a primary care clinic where HIV-related care and treatment services are offered.

In this three year study, we aim to:
- Develop a brief and scalable coping intervention for delivery in the South African HIV care setting for women with sexual trauma histories to reduce avoidant coping and traumatic stress, improve care engagement and reduce HIV risk behaviors.
- Establish the methodological details of an experimental protocol for a robust RCT to test the ImpACT intervention.
- Pilot test the ImpACT intervention with 60 HIV-infected women with histories of sexual trauma who are initiating ART.

Data collection to inform intervention development and study protocol was completed in 2015. The pilot intervention trial is ongoing, all participants are enrolled and follow up assessment will be completed during 2017.


Department & School

Duke Global Health Institute



  • NIH-National Institute of Mental Health

Project Collaborators

  • University of Cape Town

Project Status


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