3 - (SYM 125) Empowering Women Living with Co-occurring HIV Treatment Non-adherence and Intimate Partner Violence: Decreasing Violence and Increasing Safety with CBT

Background. Of the 7 million people living with HIV in South Africa, just under one million have initiated antiretroviral therapy (ART) and remain unsuppressed. One major barrier to consistent treatment access and maintenance is the moderating impact of intimate partner violence (IPV), which nearly 50% of HIV-infected women have experienced. The Common Elements Treatment Approach (CETA) is a multi-problem, evidence-based intervention that addresses mental health problems (e.g., depression, trauma, anxiety, substance use) and has shown to decrease mental health symptoms and IPV among violence-affected women (Murray et al, 2020) in other trials. Thus, CETA may be a promising intervention to impact HIV outcomes through addressing the indirect effects of IPV on adherence and continuity of care.

Methods/Design. We are conducting a randomized controlled trial of HIV-infected women, with or without their male partners, who have experienced IPV and have an unsuppressed viral load or have defaulted on treatment to test the effect of CETA in increasing retention and viral suppression, and reducing violence. Of the total RCT sample of 400 women, preliminary outcomes from baseline and implementation information from two outpatient community health clinics of 278 women (141 randomized to CETA and 137 to control arm) will be presented. 

Results. Baseline results from 278 women participants showed high rates of trauma (50%), depression (44.5%), and alcohol and substance use (5.5% comorbid with trauma and/or depression), with co-occurring suicidal (40.9% low risk, 18.18% medium risk and 15.8% high risk, 49.7% with history of attempt) and homicidal risk (37.1% low risk, 18.3% medium, and 4.2% at high risk, with 33.8% reporting previous attempt). All participants experienced IPV in the past 12 months (10% Verbal Only, 90% Physical Violence), with 76% of the participants experiencing current, ongoing IPV. A case study will highlight the adaptation and implementation of safety protocols to decrease IPV and meet treatment objectives within the current setting.

Conclusion. Findings indicate the high co-morbidity of mental/behavioral health symptoms, IPV, other safety issues (e.g., suicidal and homicidal ideation) with HIV treatment non-adherence. With cultural and setting adaptations to treatment protocols and provision, CETA appears to be a promising approach to integrate into HIV clinics.