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Improving AIDS Care After Trauma (ImpACT): Pilot Outcomes of a Co** intervention Among HIV-Infected Women with Sexual Trauma in South Africa

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Abstract

Improving AIDS Care after Trauma (ImpACT), a co** intervention for HIV-infected women with sexual abuse histories, was evaluated for feasibility and potential efficacy in a public clinic in Cape Town, South Africa. Sixty-four participants were enrolled prior to starting antiretroviral therapy (ART). After completing baseline assessments, participants were randomly assigned to standard of care (SoC: three adherence counseling sessions) or ImpACT (SoC plus four individual and three group sessions). Participants completed assessments at 3 months (after individual sessions) and 6 months post-baseline. In exploratory analysis of primary outcomes, ImpACT participants, compared to SoC, reported greater reductions in avoidance and arousal symptoms of 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 co**. In analysis of secondary outcomes, high levels of non-adherence to ART and poor care engagement were evident at 6 months, with no differences between study arms. 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. Trial Registration: ClinicalTrials.gov NCT02223390.

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Acknowledgements

This study was funded by a Grant from NIMH (R34 MH102001). We also acknowledge support received from the Duke Center for AIDS Research (P30 AI064518), and the Duke Interdisciplinary Research Training Program in AIDS (T32 AI007392). We gratefully acknowledge the participants who contributed time and energy to this study.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Kathleen J. Sikkema, Marta I. Mulawa, Melissa H. Watt, Emily M. Cherenack & Karmel W. Choi

  2. Department of Psychology and Neuroscience, Duke University, Durham, NC, USA

    Kathleen J. Sikkema, Emily M. Cherenack & Karmel W. Choi

  3. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Kathleen J. Sikkema, Corne Robertson, Nonceba Ciya, Dan J. Stein, Matapelo Kombora & John A. Joska

  4. Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Box 90086, Durham, NC, 27708-0086, USA

    Kathleen J. Sikkema

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Correspondence to Kathleen J. Sikkema.

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Sikkema, K.J., Mulawa, M.I., Robertson, C. et al. Improving AIDS Care After Trauma (ImpACT): Pilot Outcomes of a Co** intervention Among HIV-Infected Women with Sexual Trauma in South Africa. AIDS Behav 22, 1039–1052 (2018). https://doi.org/10.1007/s10461-017-2013-1

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