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Bröcker E, Scheffler F, Suliman S, Olff M, Seedat S. Participants' experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting. Glob Ment Health (Camb) 2024; 11:e36. [PMID: 38572257 PMCID: PMC10988172 DOI: 10.1017/gmh.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
We explored participants' experiences of a counsellor-supported PTSD Coach mobile application intervention (PTSD Coach-CS) in a randomised controlled trial. PTSD Coach-CS participants, who received the intervention and self-completed a custom-designed questionnaire at intervention completion were included (n = 25; female = 20; ages 19-59; isiXhosa = 22). This questionnaire comprised questions regarding the feasibility, acceptability and potential impact of the PTSD Coach-CS intervention, and general psychological support in our setting. Data were analysed using Braun and Clarke's thematic analysis. Three main themes emerged. (i) Participants' largely positive experiences of treatment procedures included the safe space created by the counsellor support in combination with the PTSD Coach application, allowing them to learn about and understand their lived experiences, and to accept their PTSD diagnoses. (ii) Positive perceptions of the PTSD Coach application, yet raising important concerns (e.g., lack of family involvement) for future consideration. (iii) Intervention-specific and systemic treatment barriers (e.g., stigma) providing important information to inform and increase the usefulness of the PTSD Coach-CS intervention. The findings suggest that the PTSD Coach-CS intervention may help address the need for access to suitable care for South African adults with PTSD. Some contextual barriers must be considered in further intervention implementation.
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Affiliation(s)
- Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Freda Scheffler
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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2
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Bröcker E, Olff M, Suliman S, Kidd M, Greyvenstein L, Seedat S. A counsellor-supported 'PTSD Coach' intervention versus enhanced Treatment-as-Usual in a resource-constrained setting: A randomised controlled trial. Glob Ment Health (Camb) 2024; 11:e7. [PMID: 38283877 PMCID: PMC10808979 DOI: 10.1017/gmh.2023.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/19/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024] Open
Abstract
To widen treatment access for posttraumatic stress disorder (PTSD) in resource-constrained South Africa, we evaluated the feasibility and effectiveness of a counsellor-supported PTSD Coach mobile application (app) (PTSD Coach-CS) intervention on PTSD and associated sequelae in a community sample. Participants (female = 89%; black = 77%; aged 19-61) with PTSD were randomised to PTSD Coach-CS (n = 32) or enhanced Treatment-as-Usual (n = 30), and assessed with the Clinician-Administered PTSD Scale (CAPS-5), PTSD Checklist (PCL-5) and Depression, Anxiety and Stress Scale-21 items, at pre- to post-treatment and follow-up (1 and 3 months). We also collected data on user experiences of the PTSD Coach app with self-administered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F3.136 = 3.33, p = 0.02) indicated a greater reduction in PTSD symptom severity over time for the intervention group with a significant between-group effect size detected at 3-month follow-up. Significant between-group effect sizes were detected in self-reported stress symptom reduction in the intervention group at post-treatment and 3-month follow-up. Participants perceived the app as helpful and were satisfied with the app. Findings suggest PTSD Coach-CS as a suitable low-cost intervention and potential treatment alternative for adults with PTSD in a resource-constrained country. Replication in larger samples is needed to fully support effectiveness. Pan African Trial Registry: PACTR202108755066871.
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Affiliation(s)
- Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Psychiatry, Stellenbosch University
| | - Lyrése Greyvenstein
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Alexander KA, Mpundu G, Duroseau B, Osian N, Chambers S, McCree D, Tobin KE, Willie TC. Intervention Approaches to Address Intimate Partner Violence and HIV: a Scoping Review of Recent Research. Curr HIV/AIDS Rep 2023; 20:296-311. [PMID: 37768511 DOI: 10.1007/s11904-023-00668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW Intimate partner violence (IPV) remains a critical challenge to HIV prevention and treatment efforts across the globe. We examined recently published (January 9, 2017-January 9, 2023) integrated behavioral interventions designed to address IPV and HIV across the care continuum. RECENT FINDINGS Fifteen studies (involving n = 10,947 participants) met the inclusion criteria for this review. Majority (n = 13) of studies focused on IPV and HIV prevention whereas two studies addressed IPV and HIV care engagement among women living with HIV. Ten studies were conducted on the African continent representing 5 countries. Most interventions (n = 11) focused on individual-level outcomes among cisgender women although two involved male partners. About half of the interventions reviewed (n = 8) showed effectiveness on both IPV and HIV outcomes compared to control groups. Integrated HIV/IPV interventions are needed to address the synergistic nature of these epidemics among marginalized populations. Future studies should focus on developing and implementing strength-based interventions among people living with HIV, men, transgender people, and Black women in the USA. Additionally, researchers and program managers should consider addressing structural and internalized stigma as potential behavioral mechanisms for improving health among people simultaneously experiencing or at-risk for HIV and IPV.
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Affiliation(s)
- Kamila A Alexander
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA.
| | - Gloria Mpundu
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - Brenice Duroseau
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - Nkemakolem Osian
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shadae Chambers
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - DaJaneil McCree
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Knettel BA, Knippler ET, Amiri I, Joel L, Madundo K, Msoka EF, Boshe J, Tarimo CS, Katiti V, Rwakilomba J, Turner EL, Minja L, Staton CA, Vissoci JRN, Mmbaga BT, Relf MV, Goldston DB. Protocol for a pilot randomized controlled trial of a telehealth-delivered counseling intervention to reduce suicidality and improve HIV care engagement in Tanzania. PLoS One 2023; 18:e0289119. [PMID: 37498916 PMCID: PMC10374000 DOI: 10.1371/journal.pone.0289119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Suicidal ideation is strikingly common among people living with HIV (PLWH) worldwide, leading to higher burden of disease, poor HIV care engagement, and loss of life. In low- and middle-income countries such as Tanzania, mental health resources are scarce, requiring innovative strategies for treatment. We describe the protocol for a clinical trial of a three-session telehealth counseling intervention to reduce suicidality and improve HIV care engagement in Tanzania. METHODS In a pilot randomized controlled trial, we will assess the feasibility, acceptability, and potential efficacy of a new telehealth intervention, termed "IDEAS for Hope". A total of 60 PLWH will be enrolled from two HIV clinics in the Kilimanjaro region and connected to telehealth counsellors based at a large regional hospital. Participants will be ≥18 years old and speak either Kiswahili or English. Patient screening will occur during routine HIV clinical care to identify PLWH experiencing suicidal ideation. Baseline surveys will be administered upon enrollment and participants will be randomized 1:1 to receive either IDEAS for Hope or the comparison condition, a brief safety planning session. All participants will receive an additional referral for psychiatric treatment. Follow-up assessment will occur at three months. IDEAS for Hope is informed by a Motivational Interviewing-enhanced safety planning intervention (MI-SafeCope) and our formative work in Tanzania. The model consists of Four Pillars: living healthy with HIV, managing HIV stigma, seeking social support, and meeting basic needs. Together, these mechanisms serve as a foundation for developing a sense of safety and hope for the future. Outcome measures will include intervention feasibility, acceptability, participant suicidality, and HIV care engagement. SIGNIFICANCE Innovative, telehealth-based counseling represents a promising treatment for suicidality among PLWH in low-resource settings. Results from this pilot trial will inform intervention refinement and parameter estimates for a future clinical trial powered to evaluate effectiveness.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Elizabeth T. Knippler
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Center for AIDS Research, Durham, NC, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, NC, United States of America
| | - Louise Joel
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Elizabeth F. Msoka
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | | | - Elizabeth L. Turner
- Duke Global Health Institute, Durham, NC, United States of America
- Duke Department of Biostatistics & Bioinformatics, Durham, NC, United States of America
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, NC, United States of America
- Duke Department of Emergency Medicine, Durham, NC, United States of America
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Durham, NC, United States of America
- Duke Department of Emergency Medicine, Durham, NC, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, United States of America
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Brown SJ, Carter GJ, Halliwell G, Brown K, Caswell R, Howarth E, Feder G, O'Doherty L. Survivor, family and professional experiences of psychosocial interventions for sexual abuse and violence: a qualitative evidence synthesis. Cochrane Database Syst Rev 2022; 10:CD013648. [PMID: 36194890 PMCID: PMC9531960 DOI: 10.1002/14651858.cd013648.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is well-established that experiencing sexual abuse and violence can have a range of detrimental impacts; a wide variety of interventions exist to support survivors in the aftermath. Understanding the experiences and perspectives of survivors receiving such interventions, along with those of their family members, and the professionals who deliver them is important for informing decision making as to what to offer survivors, for developing new interventions, and enhancing their acceptability. OBJECTIVES This review sought to: 1. identify, appraise and synthesise qualitative studies exploring the experiences of child and adult survivors of sexual abuse and violence, and their caregivers, regarding psychosocial interventions aimed at supporting survivors and preventing negative health outcomes in terms of benefits, risks/harms and barriers; 2. identify, appraise and synthesise qualitative studies exploring the experiences of professionals who deliver psychosocial interventions for sexual abuse and violence in terms of perceived benefits, risks/harms and barriers for survivors and their families/caregivers; 3. develop a conceptual understanding of how different factors influence uptake, dropout or completion, and outcomes from psychosocial interventions for sexual abuse and violence; 4. develop a conceptual understanding of how features and types of interventions responded to the needs of different user/survivor groups (e.g. age groups; types of abuse exposure; migrant populations) and contexts (healthcare/therapeutic settings; low- and middle-income countries (LMICs)); 5. explore how the findings of this review can enhance our understanding of the findings from the linked and related reviews assessing the effectiveness of interventions aimed at supporting survivors and preventing negative health outcomes. SEARCH METHODS In August 2021 we searched MEDLINE, Embase, PsycINFO and nine other databases. We also searched for unpublished reports and qualitative reports of quantitative studies in a linked systematic review, together with reference checking, citation searches and contacting authors and other researchers to identify relevant studies. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that were linked to a psychosocial intervention aimed at supporting survivors of sexual abuse and violence. Eligible studies focused on at least one of three participant groups: survivors of any age, gender, sexuality, ethnicity or [dis]ability who had received a psychosocial intervention; their carers, family members or partners; and professionals delivering such interventions. We placed no restrictions in respect of settings, locations, intervention delivery formats or durations. DATA COLLECTION AND ANALYSIS Six review authors independently assessed the titles, abstracts and full texts identified. We extracted data using a form designed for this synthesis, then used this information and an appraisal of data richness and quality in order to stratify the studies using a maximum variation approach. We assessed the methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We coded directly onto the sampled papers using NVivo and synthesised data using a thematic synthesis methodology and used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We used a narrative synthesis and matrix model to integrate our qualitative evidence synthesis (QES) findings with those of intervention review findings. MAIN RESULTS We identified 97 eligible studies and sampled 37 of them for our analysis. Most sampled studies were from high-income countries, with four from middle-income and two from low-income countries. In 27 sampled studies, the participants were survivors, in three they were intervention facilitators. Two included all three of our stakeholder groups, and five included two of our groups. The studies explored a wide range of psychosocial interventions, with only one type of intervention explored in more than one study. The review indicates that features associated with the context in which interventions were delivered had an impact on how individuals accessed and experienced interventions. This included organisational features, such as staff turnover, that could influence survivors' engagement with interventions; the setting or location in which interventions were delivered; and the characteristics associated with who delivered the interventions. Studies that assess the effectiveness of interventions typically assess their impact on mental health; however, as well as finding benefits to mental health, our QES found that study participants felt interventions also had positive impacts on their physical health, mood, understanding of trauma, interpersonal relationships and enabled them to re-engage with a wide range of areas in their lives. Participants explained that features of interventions and their contexts that best enabled them to benefit from interventions were also often things that could be a barrier to benefiting from interventions. For example, the relationship with the therapist, when open and warm was a benefit, but if such a relationship could not be achieved, it was a barrier. Survivors' levels of readiness and preparedness to both start and end interventions could have positive (if they were ready) or negative (if they were not) impacts. Study participants identified the potential risks and harms associated with completing interventions but felt that it was important to face and process trauma. Some elements of interventions were specific to the intervention type (e.g. faith-based interventions), or related to an experience of an intervention that held particular relevance to subgroups of survivors (e.g. minority groups); these issues could impact how individuals experienced delivering or receiving interventions. AUTHORS' CONCLUSIONS We had high or moderate confidence in all but one of our review findings. Further research in low- and middle-income settings, with male survivors of sexual abuse and violence and those from minority groups could strengthen the evidence for low and moderate confidence findings. We found that few interventions had published quantitative and qualitative evaluations. Since this QES has highlighted important aspects that could enable interventions to be more suitable for survivors, using a range of methodologies would provide valuable information that could enhance intervention uptake, completion and effectiveness. This study has shown that although survivors often found interventions difficult, they also appreciated that they needed to work through trauma, which they said resulted in a wide range of benefits. Therefore, listening to survivors and providing appropriate interventions, at the right time for them, can make a significant difference to their health and well-being.
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Affiliation(s)
- Sarah J Brown
- School of Law and Society, University of the Sunshine Coast, Sippy Downs, Australia
- Faculty of Health and Applied Sciences (HAS), University of the West of England (UWE), Bristol, UK
| | - Grace J Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Gemma Halliwell
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Brown
- Department of Psychology and Sports Science, University of Hertfordshire, Hatfield, UK
| | - Rachel Caswell
- Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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Medeiros P, Gupta M, Wong H, Kazemi M, Ndung'u M, Smith S, Kishibe T, Loutfy M. Women-centred HIV care: a scoping review to understand the current state of service delivery for women living with HIV globally. AIDS Care 2022; 34:1083-1093. [PMID: 34260327 DOI: 10.1080/09540121.2021.1948498] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Women living with HIV (WLWH) face unique barriers and require specialized, integrated care that focuses on women's specific needs. We conducted a scoping review to examine factors important for a women-centred HIV care (WCHC) approach. We included published peer-reviewed articles which featured WCHC services as their central focus; included study populations of girls and WLWH aged 14 years of age or older; and contributed to the understanding of WCHC for WLWH. Seven databases were reviewed and yielded 15,332 references, of which 21 fit our inclusion criteria for the scoping review. Research findings were categorized into characteristics of the study, recommendations, and target audiences. Findings revealed WCHC as care which includes the involvement of WLWH in decisions; person-centred integrated care; integrated services including mental health; sexual and reproductive health services; trauma-informed and safe space practices; healthcare provider training; and women's care self-management. In general, current systems of care do not meet the unique needs of WLWH.
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Affiliation(s)
- Priscilla Medeiros
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Meenakshi Gupta
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Heather Wong
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Mary Ndung'u
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Stephanie Smith
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | | | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Library Services, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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Lewis NV, Munas M, Colombini M, d'Oliveira AF, Pereira S, Shrestha S, Rajapakse T, Shaheen A, Rishal P, Alkaiyat A, Richards A, Garcia-Moreno CM, Feder GS, Bacchus LJ. Interventions in sexual and reproductive health services addressing violence against women in low-income and middle-income countries: a mixed-methods systematic review. BMJ Open 2022; 12:e051924. [PMID: 35193906 PMCID: PMC8867339 DOI: 10.1136/bmjopen-2021-051924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To synthesise evidence on the effectiveness, cost-effectiveness and barriers to responding to violence against women (VAW) in sexual and reproductive health (SRH) services in low/middle-income countries (LMICs). DESIGN Mixed-methods systematic review. DATA SOURCES Medline, Embase, Psycinfo, Cochrane, Cinahl, IMEMR, Web of Science, Popline, Lilacs, WHO RHL, ClinicalTrials.gov, Google, Google Scholar, websites of key organisations through December 2019. ELIGIBILITY CRITERIA Studies of any design that evaluated VAW interventions in SRH services in LMICs. DATA EXTRACTION AND SYNTHESIS Concurrent narrative quantitative and thematic qualitative syntheses, integration through line of argument and mapping onto a logic model. Two reviewers extracted data and appraised quality. RESULTS 26 studies of varied interventions using heterogeneous outcomes. Of ten interventions that strengthened health systems capacity to respond to VAW during routine SRH consultation, three reported no harm and reduction in some types of violence. Of nine interventions that strengthened health systems and communities' capacity to respond to VAW, three reported conflicting effects on re-exposure to some types of VAW and mixed effect on SRH. The interventions increased identification of VAW but had no effect on the provision (75%-100%) and uptake (0.6%-53%) of referrals to VAW services. Of seven psychosocial interventions in addition to SRH consultation that strengthened women's readiness to address VAW, four reduced re-exposure to some types of VAW and improved health. Factors that disrupted the pathway to better outcomes included accepting attitudes towards VAW, fear of consequences and limited readiness of the society, health systems and individuals. No study evaluated cost-effectiveness. CONCLUSIONS Some VAW interventions in SRH services reduced re-exposure to some types of VAW and improved some health outcomes in single studies. Future interventions should strengthen capacity to address VAW across health systems, communities and individual women. First-line support should be better tailored to women's needs and expectations. PROSPERO REGISTRATION NUMBER CRD42019137167.
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Affiliation(s)
- Natalia V Lewis
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Muzrif Munas
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - A F d'Oliveira
- Faculty of Medicine, University of São Paulo Institute of Biomedical Sciences, Sao Paulo, Brazil
| | - Stephanie Pereira
- Faculty of Medicine, University of São Paulo Institute of Biomedical Sciences, Sao Paulo, Brazil
| | - Satya Shrestha
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
- School of Medical Sciences, Kathmandu University, Kathmandu, Nepal
| | - Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Amira Shaheen
- Faculty of Medicine and Health Sciences, An-najah National University, Nablus, State of Palestine
| | - Poonam Rishal
- School of Medical Sciences, Kathmandu University, Kathmandu, Nepal
| | - Abdulsalam Alkaiyat
- Faculty of Medicine and Health Sciences, An-najah National University, Nablus, State of Palestine
| | - Alison Richards
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Claudia M Garcia-Moreno
- Department of Reproductive Health and Research, Organisation mondiale de la Sante, Geneve, Switzerland
| | - Gene S Feder
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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8
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Wang D, Deng Q, Ross B, Wang M, Liu Z, Wang H, Ouyang X. Mental health characteristics and their associations with childhood trauma among subgroups of people living with HIV in China. BMC Psychiatry 2022; 22:13. [PMID: 34986834 PMCID: PMC8729148 DOI: 10.1186/s12888-021-03658-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV (PLWH) carry a high risk for mental health problems, which has been extensively reported in the literature. However, an understanding of mental health characteristics in different subgroups of PLWH is still limited. In the present study, we conducted a cross-sectional survey to explore mental health characteristics and their associations with childhood trauma in two major subgroups of PLWH in China. METHODS A total of 533 PLWH (213 prisoners in the prison system, and 320 outpatients) were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Childhood Trauma Questionnaire (CTQ). RESULTS From the total sample, 22.0% PLWH frequently experienced psychotic-like experiences (PLEs), 21.8% had clinically significant anxiety syndrome, 34.0% had clinically significant depressive syndrome, and 63.6% experienced at least one type of traumatic exposure during their childhood, with physical neglect being the most common. Compared to outpatients with HIV, prisoners living with HIV reported more severe mental health problems and a higher frequency of childhood trauma, with childhood trauma in turn predicting higher risk for mental health problems. Similarly, among outpatients living with HIV, both childhood emotional and sexual abuse had predictive effects on all the three mental health problems. CONCLUSIONS The study suggests that PLWH have higher risk of anxiety, depression and PLEs, and childhood trauma could serve as predicting factors for such risks. In addition, childhood trauma may play distinct roles in predicting the risk for the mental health problems, depending on different subgroup of PLWH.
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Affiliation(s)
- Dongfang Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.263785.d0000 0004 0368 7397School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Brendan Ross
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine, McGill University, Montreal, QC Canada
| | - Min Wang
- grid.508008.50000 0004 4910 8370Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Honghong Wang
- grid.216417.70000 0001 0379 7164Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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St John L, Walmsley R. The Latest Treatment Interventions Improving Mental Health Outcomes for Women, Following Gender-Based Violence in Low-and-Middle-Income Countries: A Mini Review. Front Glob Womens Health 2022; 2:792399. [PMID: 34977864 PMCID: PMC8716596 DOI: 10.3389/fgwh.2021.792399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Gender-based violence (GBV), specifically violence against women, is a worldwide pandemic. Prevalence is further escalated in low-and-middle-income countries and in humanitarian crises. Survivors are left with a combination of post-traumatic stress disorder, depression and anxiety. These mental health disorders lead to further morbidity and mortality. Despite its high prevalence and co-morbidities, gender disparities and mental health stigma globally lead to few interventions developed for this population. The aim of this review is to highlight the mental health interventions developed in the past 5 years, for women following GBV in low-and-middle-income countries. It aims to discuss their efficacy and controversies when implemented into healthcare systems, understand the gaps that remain in the field and suggest future research developments. A thorough literature search revealed 16 new interventions available for improving mental health outcomes for women following GBV in low-and-middle-income countries. Following an in-depth evaluation of the papers, one intervention was successful in effectively implementing treatment into healthcare systems-"PM+." However, it proved only to be effective in the short term. Further research must be done for improving long-term mental health outcomes. Results demonstrated poor follow-up for women engaging in group therapy. The review also highlights community workers were used in service delivery to reduce barriers accessing care. No interventions proved effective in humanitarian crises, despite GBV escalated in these settings. There are very few interventions available in comparison to the prevalence of this global health issue. Therefore, this review encourages further research and improvements in mental healthcare interventions following GBV.
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Affiliation(s)
- Lily St John
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Rebecca Walmsley
- School of Medicine, University of St Andrews, Fife, United Kingdom
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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11
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Knettel BA, Wanda L, Amiri I, Myers J, Fernandez KM, Muiruri C, Watt MH, Mmbaga BT, Relf MV. Assessing the Influence of Community Health Worker Support on Early Antiretroviral Therapy Adherence, Anticipated Stigma, and Mental Health Among People Living with HIV in Tanzania. AIDS Patient Care STDS 2021; 35:308-317. [PMID: 34375138 PMCID: PMC8380803 DOI: 10.1089/apc.2021.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In many low- and middle-income countries, community health workers (CHWs) support multiple aspects of HIV care, including patient education and counseling, adherence support, and re-engaging patients lost to care. In Tanzania, the Community-Based HIV Services program is a nationwide cohort of CHWs supporting HIV care engagement. We enrolled a prospective cohort study of 80 people initiating HIV care at two Tanzanian clinics and conducted baseline and 3-month follow-up assessments to examine the potential influence of CHW support and other factors on patient early self-reported medication adherence, depression, anxiety, attitudes about medication, and HIV stigma. The vast majority of participants reported maintaining strong antiretroviral therapy (ART) adherence during the study and endorsed beliefs that ART is beneficial for them. However, there was high occurrence of likely depression and anxiety disorders in the study sample. Patient contact with CHWs at the clinic was unexpectedly low; fewer than two-thirds of participants were informed about the CHW program and fewer than one-third ever met with a CHW. Among participants who met with a CHW, there was mixed feedback about the helpfulness of the program, and contact with a CHW did not improve medication adherence at 3-month follow-up. Male participants, those with likely depression, and those who lived further from the clinic were significantly more likely to experience adherence challenges. The study findings indicate that CHWs are currently underutilized to provide patient support and may not be producing observable benefits to patients in this setting, representing a missed opportunity to address patient challenges, including depression and anxiety.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Lisa Wanda
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Charles Muiruri
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Melissa H. Watt
- Department of Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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12
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Enane LA, Apondi E, Omollo M, Toromo JJ, Bakari S, Aluoch J, Morris C, Kantor R, Braitstein P, Fortenberry JD, Nyandiko WM, Wools‐Kaloustian K, Elul B, Vreeman RC. "I just keep quiet about it and act as if everything is alright" - The cascade from trauma to disengagement among adolescents living with HIV in western Kenya. J Int AIDS Soc 2021; 24:e25695. [PMID: 33838007 PMCID: PMC8035676 DOI: 10.1002/jia2.25695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There are approximately 1.7 million adolescents living with HIV (ALHIV, ages 10 to 19) globally, including 110,000 in Kenya. While ALHIV experience poor retention in care, limited data exist on factors underlying disengagement. We investigated the burden of trauma among disengaged ALHIV in western Kenya, and its potential role in HIV care disengagement. METHODS We performed in-depth qualitative interviews with ALHIV who had disengaged from care at two sites, their caregivers and healthcare workers (HCW) at 10 sites, from 2018 to 2020. Disengagement was defined as not attending clinic ≥60 days past a missed scheduled visit. ALHIV and their caregivers were traced through phone calls and home visits. Interviews ascertained barriers and facilitators to adolescent retention in HIV care. Dedicated questions elicited narratives surrounding traumatic experiences, and the ways in which these did or did not impact retention in care. Through thematic analysis, a conceptual model emerged for a cascade from adolescent experience of trauma to disengagement from HIV care. RESULTS Interviews were conducted with 42 disengaged ALHIV, 34 caregivers and 28 HCW. ALHIV experienced a high burden of trauma from a range of stressors, including experiences at HIV disclosure or diagnosis, the loss of parents, enacted stigma and physical or sexual violence. A confluence of factors - trauma, stigma and isolation, and lack of social support - led to hopelessness and depression. These factors compounded each other, and resulted in complex mental health burdens, poor antiretroviral adherence and care disengagement. HCW approaches aligned with the factors in this model, suggesting that these areas represent targets for intervention and provision of trauma-informed care. CONCLUSIONS Trauma is a major factor underlying disengagement from HIV care among Kenyan adolescents. We describe a cascade of factors representing areas for intervention to support mental health and retention in HIV care. These include not only the provision of mental healthcare, but also preventing or addressing violence, trauma and stigma, and reinforcing social and familial support surrounding vulnerable adolescents. In this conceptualization, supporting retention in HIV care requires a trauma-informed approach, both in the individualized care of ALHIV and in the development of strategies and policies to support adolescent health outcomes.
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Affiliation(s)
- Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Moi Teaching and Referral HospitalEldoretKenya
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Clemette Morris
- Indiana University‐Purdue University‐IndianapolisIndiana UniversityIndianapolisINUSA
| | - Rami Kantor
- Division of Infectious DiseasesDepartment of MedicineBrown University Apert Medical SchoolProvidenceRIUSA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of EpidemiologyIndiana University Fairbanks School of Public HealthIndianapolisINUSA
- Dalla Lana School of Public HealthDivision of EpidemiologyUniversity of TorontoTorontoONCanada
- Department of MedicineCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - J Dennis Fortenberry
- Division of Adolescent MedicineDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of Child Health and PediatricsCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - Kara Wools‐Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Batya Elul
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
- Department of Health System Design and Global HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Arnhold Institute for Global HealthNew YorkNYUSA
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13
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Rosen S, Grimsrud A, Ehrenkranz P, Katz I. Models of service delivery for optimizing a patient's first six months on antiretroviral therapy for HIV: an applied research agenda. Gates Open Res 2020; 4:116. [PMID: 32875281 PMCID: PMC7445417 DOI: 10.12688/gatesopenres.13159.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 01/01/2023] Open
Abstract
Differentiated models of service delivery (DSD models) for HIV treatment in sub-Saharan Africa were conceived as a way to manage rapidly expanding populations of experienced patients who are clinically "stable" on antiretroviral therapy (ART). Entry requirements for most models include at least six months on treatment and a suppressed viral load. These models thus systematically exclude newly-initiated patients, who instead experience the conventional model of care, which requires frequent, multiple clinic visits that impose costs on both providers and patients. In this open letter, we argue that the conventional model of care for the first six months on ART is no longer adequate. The highest rates of treatment discontinuation are in the first six-month period after treatment initiation. Newly initiating patients are generally healthier than in the past, with higher CD4 counts, and antiretroviral medications are better tolerated, with fewer side effects and substitutions, making extra clinic visits unnecessary. Improvements in the treatment initiation process, such as same-day initiation, have not been followed by innovations in the early treatment period. Finally, the advent of COVID-19 has made it riskier to require multiple clinic visits. Research to develop differentiated models of care for the first six-month period is needed. Priorities include estimating the minimum number and type of provider interactions and ART education needed, optimizing the timing of a patient's first viral load test, determining when lay providers can replace clinicians, ensuring that patients have sufficient but not burdensome access to support, and identifying ways to establish a habit of lifelong adherence.
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Affiliation(s)
- Sydney Rosen
- School of Public Health, Boston University, 801 Massachusetts Ave, 3rd fl, Boston, MA, 02118, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Grimsrud
- HIV Programmes & Advocacy, International AIDS Society, Cape Town, South Africa
| | | | - Ingrid Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
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14
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Muiruri C, Jazowski SA, Semvua SK, Karia FP, Knettel BA, Zullig LL, Ramadhani HO, Mmbaga BT, Bartlett JA, Bosworth HB. Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania. Patient Prefer Adherence 2020; 14:153-161. [PMID: 32021125 PMCID: PMC6987964 DOI: 10.2147/ppa.s238759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/11/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Despite improvements in treatment (eg, reduction in pill intake), antiretroviral therapy (ART) is dispensed in socially inefficient and uneconomical packaging. To make pills less conspicuous and decrease the risk of being stigmatized, people living with HIV (PLWH) often engage in self-repackaging - the practice of transferring ART from original packaging to alternative containers. This behavior has been associated with ART nonadherence and failure to achieve viral load suppression. While much of the literature on ART packaging has centered around medication adherence, patients stated preferences for ART packaging and packaging attributes that influence the observed ART nonadherence are understudied. METHODS We conducted a qualitative study to elucidate perceptions of ART packaging among PLWH at two large referral hospitals in Northern Tanzania. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed and coded. RESULTS Of the 16 participants whose data were used in the final analysis, a majority were between 36 and 55 years of age (Mean 45.5 years SD: 11.1), had primary-level education (n=11, 68.8%), were self-employed (n=9, 56.3%), reported that they had self-repacked ART (n=14, 88%), and were taking ART for more than 6 years (n=11, 68.8%). Participants identified three attributes of ART packaging that increased anticipated HIV stigma and prompted self-repackaging, including visual identification, bulkiness, and the rattling noise produced by ART pill bottles. CONCLUSION Given the drastic reduction in the number of pills required for HIV treatment, there is an opportunity to not only assess the cost-effectiveness of innovative ART packaging but also evaluate the acceptability of such packaging among PLWH in order to address stigma and improve ART adherence.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Correspondence: Charles Muiruri Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC27701, USATel +1 9196603212 Email
| | - Shelley A Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seleman K Semvua
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Francis P Karia
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Habib O Ramadhani
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Division of Epidemiology & Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John A Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Duke Heart Center Nursing Research Program, School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
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