Category: Cultural Diversity / Vulnerable Populations

Symposium

A Randomized Trial of Trauma-Focused CBT Among Orphans and Vulnerable Children in Zambia

Saturday, November 18
9:45 AM - 10:45 AM
Location: Aqua Salon A & B, Level 3, Aqua Level

Keywords: Randomized Controlled Trial | Trauma | Adolescents
Presentation Type: Symposium

Background: In Africa particularly, orphans and vulnerable children (OVC) experience multiple traumatic experiences and stressors, which cause mental health problems that contribute to risk sexual behaviors. Addressing mental health is necessary to ensure well-being of OVC and as part of HIV prevention. This trial compares the effectiveness of psychosocial counseling (PC) and Trauma-Focused Cognitive behavioral therapy (TF-CBT) in addressing OVC outcomes relevant to HIV risk behaviors, substance use, mental and behavioral health, and HIV knowledge and attitudes.


Methods: 610 adolescents (ages 13-17) living in Lusaka who were OVC and exhibited significant HIV risk behaviors were randomized to receive TF-CBT or PC. Primary outcomes were HIV risk behaviors, as measured by the World AIDS Foundation (WAF) survey and substance use. Assessment of outcomes was conducted via Audio Computer Self-Interviewing (ACASI) at baseline, within one month of treatment completion, and 6-months following treatment completion (primary timepoint of interest). Additionally, a qualitative database maintained by study staff captured implementation challenges of TF-CBT and research challenges in conducting the RCT.


Results: The trial is almost complete with final 6-month assessments occurring by end of March 2017. Preliminary baseline analysis suggests a high rate of risky sexual behaviors: among those sexually active, only 40% reported using a condom at their last sexual encounter. Similarly, only 40% reported that their most recent sexual partner had a ever had an HIV test. Approximately half of the adolescents reported substance use;13% who reported injection drug use. Effectiveness analysis will compare change in these outcomes from baseline to 6-month follow-up between the TF-CBT and PC arms. There were significant barriers of client engagement and retention, and challenges implementing TF-CBT in Ministry of Health clinics.


 Conclusions: CBT was effectively delivered by lay workers who were not professionally trained, in a diverse context with significant stressors. Several implementation barriers and solutions were addressed that increased the success of CBT implementation.

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