“I cannot change what happened to me, but I can learn to change how I feel”: A case study from ImpACT, an intervention for women with a history of sexual trauma who are living with HIV in Cape Town, South Africa.

Knettel, Brandon A.; Robertson, Corné; Ciya, Nonceba; Coleman, Jessica N.; Elliott, Shannon A.; Joska, John A.; Sikkema, Kathleen J.

doi:10.1037/pst0000263

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…Few studies have examined trauma interventions among individuals living with HIV, particularly in sub-Saharan Africa. Cognitive behavioural therapy approaches and support groups may be promising, and have recently been studied in South Africa and Rwanda among women living with HIV with experiences of trauma and sexual violence [43,[63][64][65][66].…”

Section: Discussionmentioning

confidence: 99%

“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

Enane

Apondi

Omollo

et al. 2021

J. Intern. AIDS Soc.

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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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Section: Discussionmentioning

confidence: 99%

“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

Enane

Apondi

Omollo

et al. 2021

J. Intern. AIDS Soc.

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“…Furthermore, monetary incentives were also used for this study creating potential cofounding bias. Despite this, the case study of “ImpACT” ( 41 ) showed the patient's PTSD symptoms dropped from 66/80 to 18/80 and depression scores from 52/60 to 4/60 at 6 months. Though one case report does not deter from the results of the pilot RCT.…”

Section: Discussionmentioning

confidence: 98%

The Latest Treatment Interventions Improving Mental Health Outcomes for Women, Following Gender-Based Violence in Low-and-Middle-Income Countries: A Mini Review

John

Walmsley

2021

Front. Glob. Womens Health

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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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“…The fourth section includes a pair of articles focused on psychotherapy treatments for specific disorders that frequently co-occur with HIV. One article centers on chronic pain and depression (Moitra et al, 2020), and the other article provides a case study on how psychotherapy can be used to address sexual trauma with a woman diagnosed with HIV living in South Africa (Knettel et al, 2020). The fifth and final section includes two articles that describe psychotherapy interventions for specific populations.…”

Section: This Special Issuementioning

confidence: 99%

Psychotherapy research is needed to improve clinical practice for clients with HIV.

Pantalone¹,

Budge²

2020

Psychotherapy

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This introductory article to the special issue on psychotherapy and HIV provides an overview of the state of HIV intervention research, recommendations for future psychotherapy practice, and an emphasis on how psychotherapy researchers focusing on HIV should move away from the typical public health model. We provide information about how historical bias impacts HIV clinical decision-making now. In addition, we include an analysis of how public health definitions of intervention research have limited psychotherapy research-specifically the importance of common factors and process-oriented components in psychotherapy. In this introductory article, we highlight the 13 articles that comprise the 5 following sections included in the special issue: (a) General Guidelines for Psychotherapy Practice for People With HIV, (b) HIV Stigma in Psychotherapy Process and Techniques, (c) Sexual Functioning and Romantic Relationships for People with HIV, (d) A Focus on Specific Disorders (Chronic Pain and Trauma) Comorbid With HIV, and (e) A Focus on Specific Populations (Adolescents and South African Populations). We conclude by offering recommendations to researchers to focus on the sociocultural context for clients with HIV and for psychotherapists to use an intersectional approach in their work with clients with HIV. Clinical Impact StatementQuestions: How can psychotherapists improve their clinical skills and decision-making regarding their work with people with HIV? How can psychotherapy researchers move the field forward from a primary focus on behavioral interventions? Findings: Recommendations for psychotherapy research and practice include a focus on the entire sociocultural context for clients with HIV, including using an intersectional approach and using a critical lens focused on stigma. Meaning: By using a sociocultural approach, psychotherapists and psychotherapy researchers can address HIV within interventions in ways that understand the "whole client," rather than a cluster of behavioral changes. Next Steps: Psychotherapists should receive training on how to work with clients with HIV and should use interventions that address stigma, multiple identities, and cultural context.

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“I cannot change what happened to me, but I can learn to change how I feel”: A case study from ImpACT, an intervention for women with a history of sexual trauma who are living with HIV in Cape Town, South Africa.

Cited by 5 publications

References 23 publications

“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

“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

The Latest Treatment Interventions Improving Mental Health Outcomes for Women, Following Gender-Based Violence in Low-and-Middle-Income Countries: A Mini Review

Psychotherapy research is needed to improve clinical practice for clients with HIV.

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