Jan 08, 2022; Journal of Acquired Immune Deficiency Syndrome . https://doi.org/10.1097/qai.0000000000002911
Abstract
Background: Adolescents living with HIV have elevated mental distress and suboptimal ART adherence.
Setting: Two urban clinics in Kigali, Rwanda.
Methods: A 2-arm individual randomized controlled trial compared Trauma Informed Cognitive Behavioral Therapy enhanced to address HIV (TI-CBTe) to usual care (time-matched, long-standing, unstructured support groups) with 356 12-21 year-old (M=16.78) Rwandans living with HIV. TI-CBTe included six group-based 2-hour sessions led by trained and supervised 21-25 year old Rwandans living with HIV. Participants reported their ART adherence, depression/anxiety, and PTSD symptoms at baseline, 6-, 12-, and 18-months.
Results: ART adherence was relatively high at baseline, and youth reported elevated rates of depression/anxiety and trauma symptoms. There was no differential treatment effects on adherence, but depression/anxiety improved over time. Youth with lower depression/anxiety at baseline appeared to benefit more from TI-CBTe than usual care, whereas females with high baseline distress appeared to benefit more from usual care. Youth were less likely to score in high PTSD symptom categories at follow-up, with no differential treatment effects.
Conclusions: TI-CBTe did not outperform usual care on ART adherence, possibly reflecting relatively high adherence at baseline, simplified medication regimens over time, a strong comparison condition, or because youth assigned to TI-CBTe returned to their support groups following the intervention. TI-CBTe was more effective for youth with lower depression/anxiety symptoms, whereas youth with high distress benefitted more from the support groups. TI-CBTe was feasible and acceptable, and young adults living with HIV were able to deliver a mental health intervention with fidelity. The powerful nature of the comparison group, ongoing support groups, points to the potential value of locally-crafted interventions in low resource settings.