Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial.

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling\u27s benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as depression improves without medication

Development of structured support groups for HIV-positive women in South Africa

Women living with HIV in a stigmatising community need support to cope with their HIV status. In a process of action research, a structured support group programme was designed to meet the needs of women to cope with their diagnosis and interpersonal relationships.The emphasis was on identifying their needs and developing programme material to address those needs through group participation and interaction.The programme was pilot-tested at two sites located in two townships in Tshwane, South Africa. Feedback after each session made it possible to adjust the programme to the needs of the participants. In a formative evaluation, audio-taped sessions, process notes of facilitators, and experiences of the participants were used to identify therapeutic elements, the value of the groups and the problems in the implementation process.Women reported benefit from participation in the support groups. A 10-session structured programme to be used in support groups addressing the most important needs of HIV-positive women was developed.Les femmes vivant avec le VIH dans une communauté stigmatisante ont besoin de soutien afin de faire face à leur statut de VIH.Au cours du processus de la recherche active, un programme de groupe de soutien structuré a été conçu avec le but de répondre aux besoins de ces femmes pour qu’elles puissent faire face au diagnostic et aux relations personnelles. L’important était d’identifier les besoins et de développer le matériel nécessaire au programme afin d’aborder ces besoins à travers la participation et l’interaction du groupe. Des essais pilotes du programme ont été fait dans deux sites situés dans deux banlieues à Tshwane, Afrique du Sud. La réaction au bout de chacune des sessions a permis une adaptation du programme aux besoins des participants. Durant l’évaluation formative les enregistrements de sessions, les notes du processus des animateurs et les expériences personnelles des participants ont été employé dans le but de relever les éléments thérapeutiques, l’importance de groupes et les problèmes émergeant de l’exécution du processus. Les femmes ont signalé que la participation aux groupes de soutien a été rentable. Un programme structuré, ayant dix sessions, a été aménagé pour être utilisé dans les groupes de soutien avec le but d’aborder les besoins les plus importants des femmes séropositives.This research was supported by grants 5R24-HD 043558-03 (awarded to Bridget Jeffery, University of Pretoria under the auspices of the Medical Research Council, Unit for Maternal and Infant Health Care Strategies) from the National Institute for Child and Health Development, and P30-MH62294 (Center for Interdisciplinary Research on AIDS, CIRA, awarded to Michael Merson,Yale University) from the National Institute of Mental Health, USA.http://www.sahara.org.zagv201

Drawing on resilience : piloting the utility of the Kinetic Family Drawing to measure resilience in children of HIV-positive mothers

In this article we describe how using a visual, child-friendly measure of resilience in a randomised control trial (RCT), the Kgolo Mmogo (KM) project, resulted in representative insights on resilience in a mother-child relationship where the mother is HIV-positive. We used the existing psychological method Kinetic Family Drawing (KFD) to measure resilience of young children in the qualitative phase of the concurrent mixed method RCT as the children represent cultural groups for whom standardized measures have not been developed. We use the case example of baseline KM assessment data of 6 year olds (n = 11; 3 female, 8 male). The results of the study demonstrate that the visual and qualitative data from children (KFD) added to quantitative information obtained from mothers (Vineland Adaptive Behavior Scale, VABS). Additional information from the KFD had interpretation value for VABS scores and provided a child’s perspective regarding resilience. Contrasting information from the KFD problematized mothers’ perspectives as indicated in the VABS. The absence of significant information in KFD results regarding VABS sub-domains indicates differences in the cultural/contextual conceptualization of resilience. This exploratory study indicates initial support for the cross-cultural utility of the KFD to measure resilience in young children faced with adversity.http://www.journals.co.za/ej/ejour_educat.htmlgv201

Psychosocial variables associated with coping of HIV-positive women diagnosed during pregnancy

To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of two years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women’s ability to cope and enhance their health and that of their infants.National Institute of Child Health and Human Development (NICHD) grant R24HD43558http://www.springer.com/public+health/journal/10461gv201

The coping strategies used over a two-year period by HIV-positive women who had been diagnosed during pregnancy

Structured interviews were conducted with 224 HIV-positive women diagnosed during pregnancy, at antenatal clinics in Tshwane, South Africa, in order to investigate the use of coping strategies during the first two years after diagnosis. Interviews were conducted between one and four weeks after diagnosis during pregnancy, with three follow-up interviews conducted post-partum. Coping strategies were assessed with an adapted version of the Brief COPE. It was found that active coping was used more often than avoidant coping throughout the study period. Active coping increased over time, while avoidant coping decreased at first but increased again between 6 and 21 months after diagnosis. The most frequently used coping strategies included acceptance, direct action, positive reframing, religion and distraction. At first, women coped through internalised strategies. Over time, outwardfocused strategies developed. Avoidant coping patterns differed from previous research indicating that women diagnosed during pregnancy deal with the consequences of HIV after the baby is born. Recommendations for mental health services are made.National Institute of Child Health and Human Development (NICHD) grant R24HD43558http://www.tandfonline.com/loi/caic20hb201

Support group processes : perspectives from HIV-infected women in South Africa

This study examined the experiences and perceived benefits of support group participation among HIV-infected women in South Africa. From a qualitative analysis of responses, key psychological processes through which support groups are potentially beneficial were identified. These processes included identification, modelling, acceptance, and empowerment. The participants’ consequent life changes were explored in order to associate these processes with the positive outcomes of support group participation. Through understanding the relationship between the psychological processes within a support group setting and the potential benefits, and by targeting these processes in the development and implementation of future support group interventions, a framework is provided for achieving positive outcomes associated with support group participation.NICHD grant R24HD43558http://www.tandfonline.com/loi/uqrp20gv201

Correlates of HIV testing among abused women in South Africa

Gender-based violence increases a woman’s risk for HIV but little is known about her decision to get tested. We interviewed 97 women seeking abuse-related services from a nongovernmental organization (NGO) in Johannesburg, South Africa. Forty-six women (47%) had been tested for HIV. Caring for children (odds ratio [OR] = 0.27, 95% confidence interval [CI] = [0.07, 1.00]) and conversing with partner about HIV (OR = 0.13, 95% CI = [0.02, 0.85]) decreased odds of testing. Stronger risk-reduction intentions (OR = 1.27, 95% CI = [1.01, 1.60]) and seeking help from police (OR = 5.51, 95% CI = [1.18, 25.76]) increased odds of testing. Providing safe access to integrated services and testing may increase testing in this population. Infection with HIV is highly prevalent in South Africa where an estimated 16.2% of adults between the ages of 15 and 49 have the virus. The necessary first step to stemming the spread of HIV and receiving life-saving treatment is learning one’s HIV serostatus through testing. Many factors may contribute to someone’s risk of HIV infection and many barriers may prevent testing. One factor that does both is gender-based violence.The authors disclosed that they received the following support for their research and/or authorship of this article: This research was supported by grants WAF 244 (01-016; awarded to Kathleen Sikkema, PhD) from the World AIDS Foundation, and D43-TW05808 from the NIH Fogarty International Center and P30-MH62294 Center for Interdisciplinary Research on AIDS (CIRA) from NIMH (awarded to Michael H. Merson, MD). Dr. Adams was supported by 5KL2RR024127-03 from the NIH National Center for Research Resources.http://www.sagepub.co.uk/journalsProdDesc.nav?prodId=Journal20083

Development and piloting of a mother and child intervention to promote resilience in young children of HIV-infected mothers in South Africa

This paper describes the process of developing a parallel intervention for HIV-positive mothers and their youngchildren (6–10 years) with a view to strengthening the relationship between them. Strong mother–child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother–child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their youngchildren. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother–child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere.The National Institute of Mental Health (NIMH) grant R01 MH076442-01.http://www.elsevier.com/locate/evalprogplangv201

Longitudinal cohort study of depression, post-traumatic stress, and alcohol use in South African women who attend alcohol serving venues

CITATION; Abler, L.A. et al. 2014. Longitudinal cohort study of depression, post-traumatic stress, and alcohol use in South African women who attend alcohol serving venues. BMC Psychiatry, 14(1):224, doi:10.1186/s12888-014-0224-9.The original publication is available at http://www.biomedcentral.com/1471-244X/14/224Background: In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudinal relationship between psychological distress and alcohol use among South African women who attend alcohol serving venues. Methods Four waves of data were collected over the course of a year from 560 women in a Cape Town township who attended drinking venues. At each assessment wave, participants reported depressive symptoms, post-traumatic stress symptoms, and alcohol use. Multilevel growth models were used to: 1) assess the patterns of alcohol use; 2) examine how depressive symptoms uniquely, post-traumatic stress symptoms uniquely, and depressive and post-traumatic stress symptoms together were associated with alcohol use; and 3) characterize the within person and between person associations of depressive symptoms and post-traumatic stress symptoms with alcohol use. Results Women reported high levels of alcohol use throughout the study period, which declined slightly over time. Post-traumatic stress symptoms were highly correlated with depressive symptoms. Modeled separately, both within person and between person depressive and post-traumatic stress symptoms were uniquely associated with alcohol use. When modeled together, significant between person effects indicated that women who typically have more post-traumatic stress symptoms, when controlling for depressive symptoms, are at risk for increased alcohol use; however, women with more depressive symptoms, controlling for post-traumatic stress symptoms, do not have differential risk for alcohol use. Significant within person effects indicated an interaction between depressive and post-traumatic stress symptoms; women reported more alcohol use than usual at times when they had higher post-traumatic stress symptoms, and this increase in alcohol use was further exacerbated for women who also had higher depressive symptoms than usual. Conclusions These findings suggest that interventions targeting post-traumatic stress, especially when post-traumatic stress is comorbid with depression, may reduce alcohol use among South African women who drink.Publishers' Versio

Impact of structured support groups for pregnant South African women recently diagnosed HIV positive

The authors of this study evaluated a structured 10-session psy- chosocial support group intervention for newly HIV-diagnosed pregnant South African women. Participants were expected to display increases in HIV disclosure, self-esteem, active coping and positive social support, and decreases in depression, avoidant coping, and negative social support. Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006. Using a quasi-experimental design, assessments were conducted at baseline and two and eight months post-intervention. A series of random effects regression analyses were conducted, with the three assessment points treated as a random effect of time. At both follow-ups, the rate of disclosure in the intervention group was significantly higher than that of the comparison group (p < 0.001). Compared to the comparison group at the first follow-up, the intervention group displayed higher levels of active coping (t = 2.68, p < 0.05) and lower levels of avoidant coping (t = -2.02, p < 0.05), and those who attended at least half of the intervention sessions exhibited improved self-esteem (t = 2.11, p < 0.05). Group interventions tailored for newly HIV positive pregnant women, implemented in resource-limited settings, may accelerate the process of adjusting to one’s HIV status, but may not have sustainable benefits over time.http://www.tandfonline.com/loi/wwah2