Research Training on HIV Prevention and Treatment in Children and Adolescents

University Of Nairobi, Nairobi

Investigators

Abstract

Project Summary There is a high prevalence of post-traumatic stress disorder (PTSD) and depression among women. These conditions are underdiagnosed and undertreated in Kenya and have been associated with poor adherence to antiretroviral therapy (ART) and poor retention in care. Evidence from observational and intervention studies demonstrates that trauma-focused cognitive behavioral therapy (TF-CBT) ameliorates symptoms of PTSD and depression and is an effective psychological treatment for adults who have experienced interpersonal or complex trauma and sexual violence. We hypothesize that TF-CBT mediated resolution of PTSD, depression, anxiety disorders, and demoralization syndrome, a condition characterized by loss of meaning in life and feelings of helplessness, will result in improved ART adherence, engagement in care, and viral suppression among women who are primary caregivers for children exposed to or living with HIV and contribute to the global goals of Ending AIDS in children by 2030 in Kenya. Our proposal builds on the primary D43 aims of building research capacity to address HIV in children and reduce vertical HIV transmission. Additionally, by providing support for a University of Nairobi faculty member to perform this innovative and impactful research, we will lay a foundation within the institution for further research to improve women’s mental health and well-being, while advancing the individual faculty member’s research career. Our Specific aims are: AIM 1: Determine prevalence of PTSD, depression and demoralization syndrome among women who are mothers of children exposed to or living with HIV admitted to Kenyatta National Hospital (KNH) and Mbagathi County Hospital and determine their associations with women’s knowledge of HIV status, adherence to treatment and retention in care. Parents will be interviewed to determine socio-demographic characteristics, and screened for depression, PTSD and demoralization syndrome using standardized tools. AIM 2: Evaluate the feasibility, acceptability and effectiveness (measured by improved PTSD, depression and demoralization syndrome scores, engagement in care, adherence to ART and viral suppression) at 3 and 6 months post provision of TF-CBT to women who are mothers of children receiving inpatient or outpatient HIV services at KNH. Caregivers will be offered 8-12 sessions of TF-CBT, with follow-up interviews at the end of the sessions and at 3 and 6 months to determine the impact.