Journal article
Effectiveness of trauma-focused cognitive behavioral therapy compared to psychosocial counseling in reducing HIV risk behaviors, substance use, and mental health problems among orphans and vulnerable children in Zambia: a community-based randomized controlled trial
AIDS and behavior, v 28(1)
Jan 2024
PMID: 37812272
Abstract
Orphans and vulnerable children (OVC) in sub-Saharan Africa are at high risk for HIV infection and transmission. HIV prevention and treatment efforts with OVC are hindered by mental health and substance use problems. This randomized controlled trial compared a mental health intervention, Trauma Focused Cognitive Behavioral Therapy (TF-CBT), to an enhanced version of an existing HIV Psychosocial Counseling (PC+) program among 610 adolescents who met PEPFAR criteria for OVC and had HIV risk behaviors in Lusaka, Zambia. Outcomes included HIV risk behaviors (e.g., risky sexual behaviors), mental health (internalizing symptoms, externalizing behaviors, PTSD) and substance use. At 12-month follow-up, there were significant within group reductions in both groups for all outcomes, with the only significant between group difference being for substance use, in which OVC who received TF-CBT had significantly greater reductions than OVC who received PC+. In a subgroup analysis of OVC with high levels of PTSD symptoms, TF-CBT was superior to PC + in reducing internalizing symptoms, functional impairment, and substance use. Findings support TF-CBT for reducing substance use among OVC. Subgroup analysis results suggest that a robust intervention such as TF-CBT is warranted for OVC with significant mental and behavioral health comorbidities. The similar performance of TF-CBT and PC + in the overall sample for risky sexual behavior and mild mental health problems indicates that enhancing existing psychosocial programs, such as PC, with standard implementation factors like having a defined training and supervision schedule (as was done to create PC+) may improve the efficacy of HIV risk reduction efforts.Clinical Trials Number: NCT02054780
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Details
- Title
- Effectiveness of trauma-focused cognitive behavioral therapy compared to psychosocial counseling in reducing HIV risk behaviors, substance use, and mental health problems among orphans and vulnerable children in Zambia: a community-based randomized controlled trial
- Creators
- Jeremy C. Kane (Corresponding Author) - Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10027 USACaleb Figge - Johns Hopkins UniversityAlejandra Paniagua-Avila - Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10027 USASusan Michaels-Strasser - Columbia UniversityChristopher Akiba - University of North Carolina at Chapel HillMwamba Mwenge - Centre for Infectious Disease Research in ZambiaSaphira Munthali - Centre for Infectious Disease Research in ZambiaPaul Bolton - Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mental Hlth, Baltimore, MD 21205 USAStephanie Skavenski - Johns Hopkins UniversityRavi Paul - University of ZambiaFrancis Simenda - Ministry of HealthKathryn Whetten - Duke Institute for Health InnovationJudith Cohen - Drexel UniversityKristina Metz - Johns Hopkins UniversityLaura K. Murray - Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mental Hlth, Baltimore, MD 21205 USA
- Publication Details
- AIDS and behavior, v 28(1)
- Publisher
- SPRINGER/PLENUM PUBLISHERS; NEW YORK
- Number of pages
- 19
- Grant note
- The study was implemented in collaboration with several local partners: the Zambian Ministry of Community Development, Mother and Child Health, the District Health Management Team, the University of Zambia, the Elizabeth Glazer Pediatric AIDS Foundation (EGPAF), Serenity Harm Reduction Programme Zambia (SHARPZ), Centre for Infectious Disease Research in Zambia (CIDRZ), Catholic Relief Services, and the Archdiocese of Lusaka (ADL). We thank all partners and study participants for their time and efforts on this project.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001151327800005
- Scopus ID
- 2-s2.0-85173925595
- Other Identifier
- 991021861193104721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas