Category: Cultural Diversity / Vulnerable Populations


A Case Series Study of A Tailored Cognitive Behavioral Intervention for Black Women with HIV

Saturday, November 18
10:15 AM - 11:45 AM
Location: Indigo Ballroom E, Level 2, Indigo Level

Keywords: African Americans | Women's Health | HIV / AIDS
Presentation Type: Symposium

Background: Evidence-based cognitive behavioral therapy (CBT) strategies can be effective in reducing trauma symptoms, improving medication adherence, and enhancing adaptive coping. However, CBT interventions need to be tailored to the needs of marginalized groups to maximize their uptake and ultimate implementation. Black women living with HIV (BWLWH) face numerous psychosocial factors (e.g. trauma, racism, HIV-related discrimination and gender role expectations) that are associated with low medication adherence. A case series study of a tailored intervention to improve medication adherence and decrease trauma symptoms among BWLWH was conducted.

Methods: Five BWLWH were recruited and enrolled at a hospital to evaluate the preliminary acceptability/feasibility of a tailored intervention. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session intervention aimed at improving medication adherence for BWLWH by combining evidence-based cognitive behavioral strategies for trauma symptom reduction, strategies for coping with racial and HIV-related discrimination, gender empowerment, problem solving techniques for medication adherence, and resilient coping.  Assessments were conducted at baseline and at 3- and 6- month follow-up visits and consisted of self-report measures (e.g. Davidson Trauma Scale) and a clinical interview. Participants were also given an electronic medication monitor to use from baseline through the follow-up periods.

Results: Participants’ mean age was 47.4 years, two completed some college and three graduated from high school, five lived in stable housing, and five received social security disability insurance (SSDI) as a main source of income. From baseline to the 3-month post-intervention visit three participants had an improvement in their HIV medication adherence (Case 1 [71 to 100], Case 2 [54 to 100], and Case 5 [84 to 93]), one participant maintained a high level of adherence [Case 4 100 to 100], and one participant (Case 3) who was reluctant to start medication at baseline began ART after the intervention. In addition, all five participants had a decrease in trauma symptoms from baseline to 3 months post-intervention (Case 1 [73 to 6], Case 2 [54 to 100], Case 3 [26 to 2], Case 4 [17 to 2], and Case 5 [73 to 44]).

Conclusion: Preliminary findings support the potential promise of the STEP-AD intervention that tailors CBT strategies to improve HIV medication adherence and decrease trauma symptoms among BWLWH, who face multiple psychosocial adversities. A pilot randomized control trial comparing STEP-AD to a control condition is needed to evaluate the preliminary efficacy of STEP-AD.

Sannisha K. Dale

Assistant in Psychology and Instructor
Massachusetts General Hospital/Harvard Medical School


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