Browsing by Author "Sikkema, Kathleen J"
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Item Open Access A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults.(J Behav Med, 2011-04) Heckman, Timothy G; Sikkema, Kathleen J; Hansen, Nathan; Kochman, Arlene; Heh, Victor; Neufeld, Sharon; AIDS and Aging Research GroupThis research tested if a 12-session coping improvement group intervention (n = 104) reduced depressive symptoms in HIV-infected older adults compared to an interpersonal support group intervention (n = 105) and an individual therapy upon request (ITUR) control condition (n = 86). Participants were 295 HIV-infected men and women 50-plus years of age living in New York City, Cincinnati, OH, and Columbus, OH. Using A-CASI assessment methodology, participants provided data on their depressive symptoms using the Geriatric Depression Screening Scale (GDS) at pre-intervention, post-intervention, and 4- and 8-month follow-up. Whether conducted with all participants (N = 295) or only a subset of participants diagnosed with mild, moderate, or severe depressive symptoms (N = 171), mixed models analyses of repeated measures found that both coping improvement and interpersonal support group intervention participants reported fewer depressive symptoms than ITUR controls at post-intervention, 4-month follow-up, and 8-month follow-up. The effect sizes of the differences between the two active interventions and the control group were greater when outcome analyses were limited to those participants with mild, moderate, or severe depressive symptoms. At no assessment period did coping improvement and interpersonal support group intervention participants differ in depressive symptoms.Item Open Access Correlates of HIV testing among abused women in South Africa.(Violence Against Women, 2011-08) Adams, Julie L; Hansen, Nathan B; Fox, Ashley M; Taylor, Baishakhi B; van Rensburg, Madri Jansen; Mohlahlane, Rakgadi; Sikkema, Kathleen JGender-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.Item Open Access Evaluating the Impact of the Positive Choices Intervention on Substance Use, Psychological, and Care Engagement Outcomes Relevant to Current National HIV Prevention Goals(2016) Drabkin, Anya SoftleyThe HIV epidemic in the United States continues to be a significant public health problem, with approximately 50,000 new infections occurring each year. National public health priorities have shifted in recent years towards targeted HIV prevention efforts among people living with HIV/AIDS (PLWHA) that include: increasing engagement in and retention in care, improving HIV treatment adherence, and increasing screening for and treatment of substance use and psychological difficulties. This study evaluated the efficacy of Positive Choices (PC), a brief, care-based, theory-driven, 3-session counseling intervention for newly HIV-diagnosed men who have sex with men (MSM), in the context of current national HIV prevention priorities. The study involved secondary analysis of data from a preliminary efficacy trial of the PC intervention (n=102). Descriptive statistics examined baseline substance use, psychological characteristics and strategies, and care engagement and HIV-related biological outcomes. Generalized Estimating Equations (GEE) examined longitudinal changes in these variables by study condition. Results indicated that PC improved adherence to HIV treatment, but increased use of illicit drugs, specifically amyl nitrates and other stimulant drugs; additionally, moderation analyses indicated differences in patterns of change over time in viral load by baseline depression status. Implications of the findings and suggestions for future research are discussed.
Item Open Access Examining Partner Characteristics and ARV Adherence Among South African Women Who Have Experienced Sexual Trauma(2018) Elliott, Shannon AlyneBackground: Prior studies have produced conflicting results regarding the associations between partner-level characteristics and antiretroviral treatment (ART) adherence, with some findings suggesting that romantic or sexual partners negatively impact ART adherence in women. This study aimed to examine ART adherence in association with individual- and partner-level factors among South African women with sexual trauma histories, a particularly vulnerable group with low levels of ART adherence. Methods: Data were collected as part of a larger trial of HIV-infected women with trauma histories in Cape Town. A structured survey assessed partner characteristics, including the frequency of partner drinking and serostatus-disclosure, as well as individual-level factors. The level of ART nonadherence was measured in the parent trial through medical record abstraction. Univariate and multivariate linear regression analyses were used to explore possible individual- and partner-level predictors of ART nonadherence. Log likelihood ratio tests were used to examine the possible moderation of disclosure on the association between hazardous drinking and ART nonadherence. Results: The combination of hazardous drinking and partner drinking accounted for a significant percentage of the variance in ART nonadherence (F(2, 41) = 3.632, p < .05). HIV-serostatus disclosure was found to significantly modify the relationship between hazardous drinking and nonadherence (LR chi2(1) = 5.67, p < .05). Conclusions: This study found that the frequency of partner drinking and hazardous drinking were significantly associated with ART nonadherence in HIV-seropositive South African women. These analyses additionally found that HIV-serostatus disclosure to a partner exacerbated the effects of hazardous drinking on nonadherence. These findings point to the importance of addressing problem drinking in women and men, and of considering the impact of partners on ART adherence.
Item Open Access Feasibility of integrated depression care in an HIV clinic.(Psychiatr Serv, 2011-07) Adams, Julie; Pollard, R Scott; Sikkema, Kathleen JItem Open Access Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries.(Glob Ment Health (Camb), 2015-01) Sikkema, Kathleen J; Dennis, Alexis C; Watt, Melissa H; Choi, Karmel W; Yemeke, Tatenda T; Joska, John APeople living with HIV (PLWH) experience greater psychological distress than the general population. Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms, quality of life, and HIV care engagement. However, little is known about the effectiveness of mental health interventions for PLWH in low and middle-income countries (LMICs), where the large majority of PLWH reside. This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these settings. A systematic search strategy was undertaken to identify peer-reviewed published papers of intervention trials addressing negative psychological states or disorders (e.g., depression, anxiety) among PLWH in LMIC settings. Search results were assessed against pre-established inclusion and exclusion criteria. Data from papers meeting criteria were extracted for synthesis. Twenty-six papers, published between 2000 and 2014, describing 22 unique interventions were identified. Trials were implemented in sub-Saharan Africa (n=13), Asia (n=7), and the Middle East (n=2), and addressed mental health using a variety of approaches, including cognitive-behavioral (n=18), family-level (n=2), and pharmacological (n=2) treatments. Four randomized controlled trials reported significant intervention effects in mental health outcomes, and eleven preliminary studies demonstrated promising findings. Among the limited mental health intervention trials with PLWH in LMICs, few demonstrated efficacy. Mental health interventions for PLWH in LMICs must be further developed and adapted for resource-limited settings to improve effectiveness.Item Open Access Postpartum Depression in the Intergenerational Transmission of Child Maltreatment: Longitudinal Evidence from Global Settings(2017) Choi, Karmel WongChildhood maltreatment is a potent and common form of early trauma that not only produces negative outcomes for individuals during their lifetime, but may also have consequences for the next generation. Mothers who have experienced childhood maltreatment are more likely to have children also exposed to maltreatment, a phenomenon known as the intergenerational transmission of maltreatment. The perinatal period, the earliest point of intersection between generations, may offer an opportunity to interrupt such transmission. This dissertation leveraged two longitudinal studies in diverse global settings to examine how childhood maltreatment influences maternal mental health during the postpartum period, in turn impacting children’s risk for maltreatment exposure and related outcomes. In Study 1, a UK-based longitudinal cohort of 1,116 mothers and their twin children (E-Risk) was used to: (1) explore maternal childhood maltreatment as a risk factor for postpartum depression; (2) test the bridging role of postpartum depression between maternal childhood maltreatment and long-term child outcomes, specifically child exposure to maltreatment, internalizing symptoms, and externalizing symptoms; and (3) examine the intergenerational effects of specific maltreatment subtypes. Structural equation modeling revealed that maternal childhood maltreatment predicted postpartum depression, which in turn predicted child maltreatment exposure between 5 and 12 years and subsequent child internalizing and externalizing symptoms at 12 years. Indirect effects through postpartum depression were significant, robust across twin zygosity and child gender, and persisted after controlling for maternal covariates – though appeared to be carried by later maternal depression when included. In particular, emotional abuse emerged as a significant predictor of this pathway above and beyond other subtypes. In Study 2, similar aims were examined in a sample of 150 South African mothers followed through pregnancy and into the first postpartum year, with more proximal outcomes including maternal-infant bonding, infant development, and infant growth. Again, maternal childhood maltreatment predicted postpartum depression through 6 months, which then predicted child outcomes at 1 year. Indirect effects through postpartum depression were significant and persisted for maternal-infant bonding and infant physical growth after controlling for maternal and child covariates and accounting for antenatal distress. In particular, emotional neglect was a significant predictor of this pathway above and beyond other subtypes. Alterations in maternal emotion processing emerged as a potential explanatory mechanism. Together, findings from this dissertation underscore how postpartum depression may play a role in perpetuating negative outcomes across generations and in different global settings. Identifying and treating postpartum depression, as well as preventing its occurrence/recurrence, may help interrupt the intergenerational transmission of maltreatment and its sequelae.
Item Open Access Pregnancy, alcohol intake, and intimate partner violence among men and women attending drinking establishments in a Cape Town, South Africa township.(J Community Health, 2012-02) Eaton, Lisa A; Kalichman, Seth C; Sikkema, Kathleen J; Skinner, Donald; Watt, Melissa H; Pieterse, Desiree; Pitpitan, Eileen VThe highest rates of fetal alcohol syndrome worldwide can be found in South Africa. Particularly in impoverished townships in the Western Cape, pregnant women live in environments where alcohol intake during pregnancy has become normalized and interpersonal violence (IPV) is reported at high rates. For the current study we sought to examine how pregnancy, for both men and women, is related to alcohol use behaviors and IPV. We surveyed 2,120 men and women attending drinking establishments in a township located in the Western Cape of South Africa. Among women 13.3% reported being pregnant, and among men 12.0% reported their partner pregnant. For pregnant women, 61% reported attending the bar that evening to drink alcohol and 26% reported both alcohol use and currently experiencing IPV. Daily or almost daily binge drinking was reported twice as often among pregnant women than non-pregnant women (8.4% vs. 4.2%). Men with pregnant partners reported the highest rates of hitting sex partners, forcing a partner to have sex, and being forced to have sex. High rates of alcohol frequency, consumption, binge drinking, consumption and binge drinking were reported across the entire sample. In general, experiencing and perpetrating IPV were associated with alcohol use among all participants except for men with pregnant partners. Alcohol use among pregnant women attending shebeens is alarmingly high. Moreover, alcohol use appears to be an important factor in understanding the relationship between IPV and pregnancy. Intensive, targeted, and effective interventions for both men and women are urgently needed to address high rates of drinking alcohol among pregnant women who attend drinking establishments.Item Open Access Psychological Sequelae of Obstetric Fistula in Tanzanian Women(2015) Wilson, Sarah MosherUp to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.
Item Open Access Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.(Pilot Feasibility Stud, 2018) Kohrt, Brandon A; Jordans, Mark JD; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel, Nagendra P; Rai, Sauharda; Singla, Daisy R; Lamichhane, Jagannath; Lund, Crick; Patel, VikramBackground: Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap,REducingStigma amongHealthcAreProviders to ImprovEmental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. Methods: This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit,k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. Discussion: The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. Trial registration: ClinicalTrials.gov identifier, NCT02793271.Item Open Access Screening for Sexual Trauma, Intimate Partner Violence and Mental Health Symptoms among HIV Positive South African Women(2016) Yemeke, Tatenda TariroBackground: The psychological sequelae of sexual trauma and physical intimate partner violence (IPV) exposure can lead to poor HIV care outcomes, including poor treatment adherence. This study aimed to estimate the prevalence of and factors associated with mental health symptoms and trauma among HIV positive women. Additionally, the study aimed to assess the feasibility and acceptability of screening for trauma and mental health symptoms among HIV positive South African women. Finally, the study aimed to elicit healthcare workers’ perceptions related to sexual trauma and the provision of care and services for HIV positive women with trauma histories.
Methods: The study utilized a mixed-methods approach that included a cross-sectional survey of 70 HIV positive women recruited through referral sampling and key informant interviews with seven healthcare workers (HCWs). A study-screening instrument consisting of 24 items from standard measures was used to screen women for sexual trauma, physical intimate partner violence (IPV), depression and PTSD. Sexual trauma and IPV were assessed across the lifetime, while depression and PTSD were current assessments. Logistic regression models were used to explore the relationship between trauma exposure and mental health symptoms, while controlling for age and education. Interview transcripts were coded and analyzed for emergent themes on HCWs perceptions on sexual trauma and HIV care.
Results: Among participants, 51% had sexual trauma experience and 75% had intimate partner violence (IPV) experience. Among participants, 36% met screening criteria for major depression; among those with traumatic experiences (n=57), 70% met screening criteria for post-traumatic stress disorder (PTSD). Compared to having no sexual trauma or IPV exposure, having both sexual trauma and IPV was significantly associated with higher odds of depression (OR = 8.11; 95% CI 1.48-44.34), while having either IPV or sexual trauma individually was not significantly associated with increased odds of depression. Compared to having either IPV or sexual trauma, having both sexual trauma and IPV was not significantly associated with PTSD. Responses from participants’ feedback on screening process suggest that screening was feasible and acceptable to participants. Some of the health care workers (HCWs) did not perceive dealing with trauma to be part of their duties, but instead viewed social workers or psychologists as the appropriate health cadre to provide care related to trauma and mental health.
Conclusions: High levels of sexual trauma, IPV and mental health distress were reported among HIV positive women in this setting. Screening for trauma and mental health symptoms was acceptable to the participants, but several challenges were encountered in implementing screening. Given the potential impact of trauma and mental health on HIV care engagement, interventions to address trauma and its psychological sequelae are needed.
Item Open Access Stress, Coping, Mental Health, and Reproductive Health among Adolescent Girls Transitioning through Puberty in Tanzania(2021) Cherenack, Emily MellissaAdolescent girls in sub-Saharan Africa must transition through puberty in the context of heightened risk for reproductive tract infections and mental illness. At the same time, girls experience menstrual stigma and a lack of resources to manage menstruation. Although menstruation and other puberty-specific stressors may negatively impact girls’ well-being, little is known about the relationships between puberty-specific stressors, coping, mental health, and reproductive health among girls in sub-Saharan Africa. The present dissertation seeks to fill this gap by investigating the types of puberty-specific stressors experienced by adolescent girls and young women in Tanzania, how girls cope with stressors, and the associations between stress and coping and mental health and reproductive health. A qualitative interview study and cross-sectional survey study were conducted to explore stress, coping, and health among adolescent girls in Tanzania. Both studies showed that girls experienced significant and disruptive puberty-specific stressors, with sexual pressure and menstrual pain constituting two of the most common stressors. Stressors were associated with depression, anxiety, and reproductive tract infections. Active coping and avoidant coping showed inconsistent relationships with stressors and mental health. Overall, psychosocial interventions are needed to reduce the negative impact of puberty-specific stressors on mental health and reproductive health among adolescent girls in Tanzania.
Item Open Access THE DEVELOPMENT AND FEASIBILITY OF A BRIEF RISK REDUCTION INTERVENTION FOR NEWLY HIV-DIAGNOSED MEN WHO HAVE SEX WITH MEN.(J Community Psychol, 2011-08-01) Sikkema, Kathleen J; Hansen, Nathan B; Kochman, Arlene; Santos, Jonathan; Watt, Melissa H; Wilson, Patrick A; Delorenzo, Allyson; Laudato, Jay; Mayer, GalMen who have sex with men (MSM) represent more than half of all new HIV infections in the United States. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV-diagnosed MSM receiving HIV care in a primary care setting. Sixty-five men, within 3 months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3-month, and 6-month follow-up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff, and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated for efficacy.Item Open Access The development and psychometric properties of the HIV and Abuse Related Shame Inventory (HARSI).(AIDS Behav, 2012-05) Neufeld, Sharon AS; Sikkema, Kathleen J; Lee, Rachel S; Kochman, Arlene; Hansen, Nathan BShame has been shown to predict sexual HIV transmission risk behavior, medication non-adherence, symptomatic HIV or AIDS, and symptoms of depression and PTSD. However, there remains a dearth of tools to measure the specific constructs of HIV-related and sexual abuse-related shame. To ameliorate this gap, we present a 31-item measure that assesses HIV and sexual abuse-related shame, and the impact of shame on HIV-related health behaviors. A diverse sample of 271 HIV-positive men and women who were sexually abused as children completed the HIV and Abuse Related Shame Inventory (HARSI) among other measures. An exploratory factor analysis supported the retention of three-factors, explaining 56.7% of the sample variance. These internally consistent factors showed good test-retest reliability, and sound convergent and divergent validity using eight well-established HIV specific and general psychosocial criterion measures. Unlike stigma or discrimination, shame is potentially alterable through individually-focused interventions, making the measurement of shame clinically meaningful.Item Open Access The Impact of Marijuana Use on Memory in Patients with HIV/AIDS(2016) Skalski, Linda MarieThe most robust neurocognitive effect of marijuana use is memory impairment. Memory deficits are also high among persons living with HIV/AIDS, and marijuana use among this population is disproportionately common. Yet research examining neurocognitive outcomes resulting from co-occurring marijuana and HIV is virtually non-existent. The primary aim of this case-controlled study was to identify patterns of neurocognitive impairment among HIV patients who used marijuana compared to HIV patients who did not use drugs by comparing the groups on domain T-scores. Participants included 32 current marijuana users and 37 non-drug users. A comprehensive battery assessed substance use and neurocognitive functioning. Among the full sample, marijuana users performed significantly worse on verbal memory tasks compared to non-drug users and significantly better on attention/working memory tasks. A secondary aim of this study was to test whether the effect of marijuana use on memory was moderated by HIV disease progression, but these models were not significant. This study also examined whether the effect of marijuana use was differentially affected by marijuana use characteristics, finding that earlier age of initiation was associated with worse memory performance. These findings have important clinical implications, particularly given increased legalization of this drug to manage HIV infection.
Item Open Access The impact of shame on health-related quality of life among HIV-positive adults with a history of childhood sexual abuse.(AIDS Patient Care STDS, 2010-09) Persons, Elizabeth; Kershaw, Trace; Sikkema, Kathleen J; Hansen, Nathan BChildhood sexual abuse is prevalent among people living with HIV, and the experience of shame is a common consequence of childhood sexual abuse and HIV infection. This study examined the role of shame in health-related quality of life among HIV-positive adults who have experienced childhood sexual abuse. Data from 247 HIV-infected adults with a history of childhood sexual abuse were analyzed. Hierarchical linear regression was conducted to assess the impact of shame regarding both sexual abuse and HIV infection, while controlling for demographic, clinical, and psychosocial factors. In bivariate analyses, shame regarding sexual abuse and HIV infection were each negatively associated with health-related quality of life and its components (physical well-being, function and global well-being, emotional and social well-being, and cognitive functioning). After controlling for demographic, clinical, and psychosocial factors, HIV-related, but not sexual abuse-related, shame remained a significant predictor of reduced health-related quality of life, explaining up to 10% of the variance in multivariable models for overall health-related quality of life, emotional, function and global, and social well-being and cognitive functioning over and above that of other variables entered into the model. Additionally, HIV symptoms, perceived stress, and perceived availability of social support were associated with health-related quality of life in multivariable models. Shame is an important and modifiable predictor of health-related quality of life in HIV-positive populations, and medical and mental health providers serving HIV-infected populations should be aware of the importance of shame and its impact on the well-being of their patients.Item Open Access The impact of structured support groups for pregnant South African women recently diagnosed HIV positive.(Women Health, 2011-08-31) Mundell, Jonathan P; Visser, Maretha J; Makin, Jennifer D; Kershaw, Trace S; Forsyth, Brian WC; Jeffery, Bridget; Sikkema, Kathleen JThe authors of this study evaluated a structured 10-session psychosocial 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.Item Open Access The Long-Term Benefits of an Integrated Model to Treat Childhood Obesity(2019-04-15) Pasquale, EllenObjective: To understand short- and long-term outcomes of diverse, low-income participants in a childhood obesity intervention, and to examine participant expectations, motivators, facilitators, and barriers to program attendance and engagement. Methods: A sequential mixed-methods study design was employed: first, a retrospective analysis of an integrated clinic-community intervention cohort to identify predictors of success at the end of a six-month intervention. Then, the most and least successful participants and their parents were recruited to participate in in-depth semi-structured audio-recorded interviews. Transcripts were analyzed with a thematic analysis approach. Themes were grouped into categories including: (1) barriers and (2) facilitators and motivators of program attendance and engagement, (3) program expectations, (4) lifestyle effects, and (5) parent perceptions of effects on child health. Body mass index z-scores (BMIz) two years after intervention completion were obtained to assess long-term effects of the program. Results: Only Hispanic race was found to be a significant predictor of BMIz reduction at intervention completion. Two years after program completion, intervention participants reduced their BMIz by 0.07. Prominent barriers to program engagement included travel to intervention site and parent work schedules. Motivators included social support from family members and enjoyment of program sessions. All participants cited at least one lifestyle change, including improved diet choices and increased physical activity levels. All parents expressed satisfaction with some aspect of the program, even if their child did not lose weight. Conclusion: Results suggest a number of positive long-term outcomes associated with an integrated clinic-community treatment model, which include BMIz reduction, increased health education, positive eating changes, and increased physical activity levels.Item Open Access The protective role of religious coping in adolescents' responses to poverty and sexual decision-making in rural Kenya.(J Res Adolesc, 2012-03-01) Puffer, Eve S; Watt, Melissa H; Sikkema, Kathleen J; Ogwang-Odhiambo, Rose A; Broverman, Sherryl AIn this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and Human Immunodeficiency Virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual decision-making; the majority (29) reported religious coping with these or other stressors. Adolescents reported praying for God to partner with them to engage in positive behaviors, praying for strength to resist unwanted behaviors, and passive strategies characterized by waiting for God to provide resources or protection from HIV. Adolescents in Sub-Saharan Africa may benefit from HIV prevention interventions that integrate and build upon their use of religious coping.