HIV-infected women in South Africa report high rates of sexual trauma, which negatively impacts their mental health and potentially influences engagement in HIV care (retention in care and adherence to antiretroviral therapy) and risk behaviors. Addressing the traumatic stress resulting from sexual trauma could improve these HIV-related outcomes, which in turn may prevent HIV transmission through suppression of the virus and reduction in HIV risk behaviors. Intervention research among HIV-infected populations with trauma histories in the U.S. demonstrates that a coping approach, particularly one that reduces the use of avoidant coping strategies, is efficacious in reducing traumatic stress and improving health behaviors. Although South Africa faces dual epidemics of HIV and sexual violence, trauma treatment has not been well-integrated into the HIV care setting. The proposed 3-year study will develop and pilot test an intervention called ImpACT (Improving AIDS Care after Trauma) to reduce avoidant coping, traumatic stress, and risk behaviors, and increase engagement in care. The intervention will take place in a public ART clinic and will target women during the critical period when they initiate ART in order to maximize the impact on engagement in care. Qualitative data collection with staff, providers, and HIV-infected female patients at the study clinic will elicit feedback on the content and delivery of ImpACT and key aspects of the study protocol. ImpACT will then be piloted with 60 women who are new ART enrollees with a history of sexual trauma and elevated traumatic stress. Participants will be randomized to the control condition (standard of care, or SoC: 3 adherence counseling sessions required of all patients initiating ART at the clinic) or the intervention condition (SoC + ImpACT) and will complete assessments at baseline, 3, and 6 months post-randomization, with care engagement data extracted from medical records at the end of the study period. The study has three specific aims: 1) to develop a brief and scalable coping intervention for delivery in the South African HIV care setting for women with sexual trauma histories; 2) to establish the methodological details of an experimental protocol for a robust randomized control trial; and 3) to pilot test the ImpACT intervention with 60 HIV-infected women with histories of sexual trauma who are initiating ART in order to determine feasibility and acceptability in the HIV care setting, and explore the impact on avoidant coping, traumatic stress, engagement in care, and HIV risk behaviors. The goal at the completion of this study is to have a structured intervention curriculum that is culturally relevant for HIV infected women in South Africa, a full experimental protocol that is appropriate for the South African care setting, and data on feasibility, acceptability, and target outcomes. These products can be leveraged to inform an R01 application for rigorous evaluation of the ImpACT intervention. We are confident that this developmental work will significantly enhance the probability of success of a larger randomized control trial.

Public Health Relevance

Women in South Africa face dual epidemics of HIV and sexual violence. The resulting traumatic stress may compromise retention in HIV care and adherence to antiretroviral therapy, and increase sexual risk behavior and substance use. This study will develop and pilot a brief intervention, based on theories of stress and coping, for women with histories of sexual trauma initiating ART in South Africa. This intervention has the potential to improve care engagement and reduce risk behaviors, and therefore prevent HIV transmission.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH102001-02
Application #
8866300
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
Greenwood, Gregory
Project Start
2014-06-11
Project End
2017-05-31
Budget Start
2015-06-01
Budget End
2016-05-31
Support Year
2
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Duke University
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Sikkema, Kathleen J; Mulawa, Marta I; Robertson, Corne et al. (2018) Improving AIDS Care After Trauma (ImpACT): Pilot Outcomes of a Coping intervention Among HIV-Infected Women with Sexual Trauma in South Africa. AIDS Behav 22:1039-1052
Watt, Melissa H; Knippler, Elizabeth T; Knettel, Brandon A et al. (2018) HIV Disclosure Among Pregnant Women Initiating ART in Cape Town, South Africa: Qualitative Perspectives During the Pregnancy and Postpartum Periods. AIDS Behav 22:3945-3956
Sikkema, Kathleen J; Choi, Karmel W; Robertson, Corne et al. (2018) Development of a coping intervention to improve traumatic stress and HIV care engagement among South African women with sexual trauma histories. Eval Program Plann 68:148-156
Yemeke, Tatenda T; Sikkema, Kathleen J; Watt, Melissa H et al. (2017) Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa. J Interpers Violence :886260517718186
Watt, Melissa H; Dennis, Alexis C; Choi, Karmel W et al. (2017) Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa. AIDS Behav 21:3209-3218
Barnett, Whitney; Brittain, Kirsty; Sorsdahl, Katherine et al. (2016) Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants. Philos Ethics Humanit Med 11:3
Sikkema, Kathleen J; Dennis, Alexis C; Watt, Melissa H et al. (2015) Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries. Glob Ment Health (Camb) 2:
Zar, H J; Barnett, W; Myer, L et al. (2015) Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study. Thorax 70:592-4
Choi, Karmel W; Sikkema, Kathleen J; Velloza, Jennifer et al. (2015) Maladaptive coping mediates the influence of childhood trauma on depression and PTSD among pregnant women in South Africa. Arch Womens Ment Health 18:731-8