Women’s perspectives on ImpACT: a coping intervention to address sexual trauma and improve HIV care engagement in Cape Town, South Africa

ABSTRACT

HIV-infected women who have experienced sexual violence face unique challenges in their HIV care engagement and adherence to antiretroviral medications (ARVs). Improving AIDS Care after Trauma (ImpACT) is a brief counseling intervention aimed at reducing the negative impact of sexual trauma and HIV, building coping skills, and improving long-term HIV care engagement. We conducted a randomized controlled pilot trial of ImpACT with 64 women initiating ARVs in Cape Town, South Africa, with results suggesting the intervention can reduce PTSD symptoms and increase motivation to adhere to ARVs. For the current study, we abstracted data from ImpACT worksheets completed by 31 participants during intervention sessions, and qualitative responses from post-intervention surveys, to examine mechanisms, facilitators, and barriers to change in the intervention. Data included participant descriptions of the values informing their care, barriers to participation, and perceived benefits of the intervention related to coping with trauma and improving care engagement. During the first session, women reported feelings of shame, sadness, and anger that led to social isolation, mistrust, and damaged relationships. Barriers to participation included work and school demands, issues with transportation, finances, and discomfort in talking about HIV and trauma, particularly in group sessions. Despite these challenges, several women stated they developed more positive thinking, felt more confident, and improved their interpersonal relationships. Participants also reported substantial positive impact on symptoms of sexual trauma and motivation to continue with long-term HIV care, and clearer understanding of barriers and facilitators to ARV adherence. ImpACT is a promising intervention model for building adaptive coping skills and adherence to HIV treatment, informed by personal values, among women with a history of trauma in this high-risk setting. The data also offer insights into strategies to strengthen the intervention, overcome barriers to participation, encourage the practical application of skills, and promote long-term HIV care engagement.

KEYWORDS:

• Adherence
• antiretroviral therapy
• HIV care engagement
• sexual violence
• retention in care
• traumatic stress

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Brandon A. Knettel http://orcid.org/0000-0003-2986-1579

Marta I. Mulawa http://orcid.org/0000-0001-9687-421X

John A. Joska http://orcid.org/0000-0003-4260-1181

Kathleen J. Sikkema http://orcid.org/0000-0003-0371-5119

Additional information

Funding

This work was supported by the National Institute of Mental Health under Grant R34 MH102001. We also acknowledge support received from the Duke Center for AIDS Research (P30 AI064518), the Duke Interdisciplinary Research Training Program in AIDS , a program within the Ruth L. Kirschstein National Research Service Award (T32 AI007392), and the Duke Global Health Institute.