Building resilience: a mental health intervention for Tanzanian youth living with HIV

Figures & data

Table 1. Protocol components of Sauti ya Vijana (SYV).

Resilience	Session	Key components
	Pre group 1	Individual contact: Review SYV program; ensure consent forms are signed; discuss program logistics.
The ability to identify and cope with stressful events	Youth group 1 Held jointly with caregivers	Introduction to SYV: Describe how SYV works to benefit youth; review and sign confidentiality agreements. Separate into youth and caregiver groups. Youth describe and discuss what stress and worries exist for them living with HIV.
	Caregivers only group 1	Contribution of caregivers to SYV: Describe what will happen in youth groups; discuss how caregivers can best support their youth.
	Youth group 2	Worries, stress, and coping: Review worries and stresses; discuss coping strategies already used by youth; teach activities to become calmer in mind and body.
	Youth group 3	Thoughts, feelings, and behavior: Learn what are thoughts, feelings, and behaviors and how they affect one another.
	Youth group 4	Talking about memories: Prepare for trauma narrative “How I found out I have HIV”.
Foster strong familial and social relationships	Individual meetings 4.1	Finding out about having HIV-infection: Talk about memories one on one with a group leader; prepare to share with group (optional).
	Youth group 5	Sharing difficult memories with others: Share narrative with the group; emphasize the helpfulness of practicing sharing; emphasize that sharing is an individual choice for each youth.
	Youth group 6 Held jointly with caregivers	Sharing memories with caregiver: Practice with group leaders; meet with caregiver/supportive adult to share memories as they choose.
	Caregivers only group 6	Prepare for youth sharing: Discuss the importance of youth being able to share their memories.
	Youth group 7	Circles of support: Identify trusted support persons with the aim to increase use of social and emotional support.
Cultivate a safe and healthy living environment	Youth group 8	Stigma: Discuss identifying and coping with internal and external stigma; review how to teach about HIV transmission to cope with stigma.
	Youth group 9	Disclosure: Discuss disclosure with household persons and with sexual partners; practice disclosure in role-play.
	Youth group 10	Values and moving on positively: Identify values and how youth see themselves in six months; use client-centered approach to support youth motivation; youth describe what they value in life, how their actions may or may not reflect their values, and learn to consider their values when making choices in life.
	Individual meeting 10.1	Planning for moving on positively: Plan for group ending; review commitments to action and finding emotional support outside of the group; provide individual exit interview.
	Final celebration	Review accomplishments: Praise youth for hard work; enjoy a party to celebrate the end of the SYV work.

Table 2. Description of the participants.

Demographics	Total
	(N = 58)
Age, y
Mean (SD)	17.4 (2.3)
Median (IQR)	17.0 (16.2, 18.3)
Sex
Female, n (%)	28 (48.3%)
Mode of HIV Transmission, n (%)
Perinatally	50 (86.2%)
Unclear	8 (13.8%)
Age at HIV diagnosis (per chart), y
Median (IQR)	8.6 (5.8, 11.9)
Age at ART Start, y
Median (IQR)	9.9 (7.6, 13.4)
Primary Caregiver, n (%)
Mom or dad	30 (51.7%)
Grandmother or grandfather	13 (22.4%)
Aunt or uncle	10 (17.2%)
Brother or sister	2 (3.5%)
Other	3 (5.2%)
Orphan status, n (%)
Mom and Dad both living	14 (24.1%)
Single orphan	29 (50.0%)
Double orphan	15 (25.9%)
Socioeconomic Status, n (%)^a
Enrolled in school	40 (69.0%)
Working outside the home	6 (10.5%)
House has electricity	42 (72.4%)
House has indoor plumbing	41 (70.7%)
Owns a cell phone	36 (62.1%)
Behaviors, n (%)
Ever had sexual intercourse	13 (22.8%)
Age of sexual debut (Median, IQR)	16.0 (15.0, 17.0)
Number of partners (Median, IQR)	1.0 (1.0, 2.0)
Used a condom during most recent sexual encounter^b	10 (76.9%)
Disclosed to sexual partner^b	5 (38.5%)
Consumed alcohol in the last 6 months	5 (8.6%)

Note: IQR (interquartile range).

^aSocioeconomic Status, proxy markers presented; categories not mutually exclusive.

^bPercentage of those reporting ever having sex.

Figure 1. Session attendance to Sauti ya Vijana intervention by wave.

Table 3. Youth Identified Common Stressors and Worries and Ways of Coping

Stress and worries	Coping strategies
Worry about being isolated by the society due to HIV	Helpful	Talking to friends and/or family
Worry about disclosure of HIV status for fear of gossiping and stigma		Religion
Worry about being alone, never marrying, and not having children		Participating in sports/exercise
Worry about unintentional disclosure if seen taking antiretroviral therapy (boarding school and undisclosed family)		Watching a funny movie
Worry of getting sick and dying early, especially having witnessed the death of HIV-infected friends and family		Listening to music
Worry about not being taken seriously or being accepted in the community because of living with HIV	Unhelpful	Getting drunk or using drugs to “forget”
Worry about failing in school		Physically fighting
Worry about not having money for school fees		Getting angry and/or yelling
Worry about not getting a job