Improving the Health of South African Women with Traumatic Stress in HIV Care
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. In South Africa, trauma treatment has not been well-integrated into the HIV care setting. Therefore, 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.
In this three-year study, we developed and pilot tested Improving AIDS Care after Trauma (ImpACT), a brief intervention based on theories of stress, coping, and evidence-based treatment for traumatic stress. ImpACT was developed using an iterative process to culturally adapt a cognitive-behavioral intervention for delivery to women newly initiating antiretroviral therapy (ART) in the South African clinical setting. Feedback from key informant interviews, in-depth interviews, and a trial run helped refine session content and the adaptation of key intervention elements.
ImpACT was evaluated for feasibility and potential efficacy in a public clinic in Cape Town, South Africa, with a pilot intervention trial enrolling 64 participants. In exploratory analysis of primary outcomes, ImpACT participants, compared to Standard of Care, reported greater reductions in avoidance and arousal symptoms of posttraumatic stress disorder (PTSD) and greater increases in ART adherence motivation at 3 months. Clinically significant decreases in overall PTSD symptoms were also demonstrated at 3 months. These effects continued as trends at the 6-month assessment, in addition to increases in social/spiritual coping. A trauma-focused, culturally-adapted individual intervention delivered by a non-specialist in the HIV care setting is feasible and acceptable. Preliminary findings suggest ImpACT has potential to reduce PTSD symptoms and increase ART adherence motivation, but a more intensive intervention may be needed to improve and maintain care engagement among this population. Outcomes are published in AIDS and Behavior.
Future research goals include evaluating the effectiveness and exploring the scalability of ImpACT+ (a six-session, individual-level coping intervention, refined based on the pilot trial of ImpACT) in a full-scale trial.