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1.
AIDS Behav ; 28(1): 245-263, 2024 Jan.
Article in English | MEDLINE | ID: mdl-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.


Subject(s)
Cognitive Behavioral Therapy , Counseling , HIV Infections , Mental Disorders , Substance-Related Disorders , Adolescent , Humans , Cognitive Behavioral Therapy/methods , Counseling/methods , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/psychology , Mental Disorders/epidemiology , Mental Disorders/prevention & control , Risk-Taking , Substance-Related Disorders/epidemiology , Substance-Related Disorders/prevention & control , Zambia/epidemiology
2.
Drug Alcohol Depend ; 229(Pt A): 109156, 2021 12 01.
Article in English | MEDLINE | ID: mdl-34773884

ABSTRACT

BACKGROUND: This study evaluated the test characteristics of brief versions of the Alcohol Use Disorders Identification Test (AUDIT), the AUDIT-C and AUDIT-3, compared to the full AUDIT in populations with heavy drinking living in Zambia and compared differences in effect size estimates when using brief versions in clinical trials. METHODS: Data were obtained from two randomized trials of the Common Elements Treatment Approach (CETA) for reducing unhealthy alcohol use among adult couples and people living with HIV (PLWH) in Zambia. The full AUDIT was administered to participants at baseline and at 6- or 12-month follow-up. Sensitivity and specificity of the brief versions were calculated in comparison to the full AUDIT. Mixed effects regression models were estimated to calculate the effect sizes from the trials using the brief versions and these were compared to the originally calculated effect sizes using the full version. RESULTS: The AUDIT-C performed well at cut-off ≥ 3 for both men (sensitivity: >80%; specificity: >76%) and women (sensitivity: >84%; specificity: >88%). The AUDIT-3 performed best at cut-off ≥ 1, but with comparatively reduced validity for men (sensitivity: >77%; specificity: ≥60%) and women (sensitivity: ≥72%; specificity: >62%). Effect sizes were different by up to 52% using the AUDIT-C and up to 60% for the AUDIT-3 compared to the AUDIT. CONCLUSIONS: The AUDIT-C is recommended as a brief screening tool for community-based and clinic-based screening in Zambia among populations with high prevalence of unhealthy alcohol use. For research studies, the full AUDIT is recommended to calculate treatment effect.


Subject(s)
Alcoholism , Adult , Alcohol Drinking/epidemiology , Alcoholism/diagnosis , Alcoholism/epidemiology , Female , Humans , Male , Mass Screening , Randomized Controlled Trials as Topic , Surveys and Questionnaires , Zambia/epidemiology
3.
J Interpers Violence ; 36(19-20): NP10744-NP10765, 2021 10.
Article in English | MEDLINE | ID: mdl-31542985

ABSTRACT

Inequitable gender norms, including the acceptance of violence in intimate relationships, have been found to be associated with the occurrence of intimate partner violence (IPV) perpetration and victimization. Despite these findings, few studies have considered whether inequitable gender norms are related to IPV severity. This study uses baseline data from a psychotherapeutic intervention targeting heterosexual couples (n = 247) in Lusaka, Zambia, who reported moderate to severe male-perpetrated IPV and male hazardous alcohol use to consider: (a) prevailing gender norms, including those related to IPV; (b) the relationship between IPV acceptance and IPV severity; and (c) the relationship between inequitable gender norms and IPV severity. Multiple linear regression analyses were used to model the relationships between IPV acceptance and inequitable gender norms, and female-reported IPV severity (including threats of violence, physical violence, sexual violence, and total violence), separately among male and female participants. In general, men and women were similar in their patterns of agreement with gender norms, with both highly endorsing items related to household roles. More than three-quarters of men (78.1%) and women (78.5%) indicated overall acceptance of violence in intimate relationships, with no significant differences between men and women in their endorsement of any IPV-related gender norms. Among men, IPV acceptance was associated with a statistically significant increase in IPV perpetration severity in terms of threatening violence (B = 5.86, 95% confidence interval [CI] = [1.84, 9.89]), physical violence (B = 4.54, 95% CI = [0.10, 8.98]), and total violence (B = 11.65, 95% CI = [3.14, 20.16]). There was no association between IPV acceptance and IPV victimization severity among women. Unlike IPV acceptance, there was no evidence for a relationship between inequitable gender norms and IPV severity for either men or women. These findings have implications for the appropriateness of gender transformative interventions in targeting men and women in relationships in which there is ongoing IPV.


Subject(s)
Intimate Partner Violence , Female , Gender Identity , Humans , Male , Sexual Behavior , Sexual Partners , Zambia/epidemiology
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