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Cited by 67Intimate Partner and Family ViolencePosttraumatic Stress Disorder ResearchPsychotherapy Techniques and Applications

Interpersonal psychotherapy delivered by nonspecialists for depression and posttraumatic stress disorder among Kenyan HIV–positive women affected by gender-based violence: Randomized controlled trial

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Meffert, Susan M., Neylan, Thomas C., McCulloch, Charles E., Blum, Kelly, Cohen, Craig R., Bukusi, Elizabeth A., Verdeli, Helen, Markowitz, John C. +8 more·2021·PLOS Medicine
DOI 10.1371/journal.pmed.1003468PMC PMC7799784
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Abstract

Background: HIV–positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world’s majority of HIV–positive women live and prevalence of GBV is high. Methods and findings: We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV–positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months. Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03). Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (−6.9 [−12.2, −1.5], p = 0.01), and nonsignificantly reduced work absenteeism (−3.35 [−6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (−2.79 [−5.42, −0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed. Conclusions: IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV–positive women’s mental health, functioning, and GBV (IPV) exposure, compared to controls. Trial registration: Clinical Trials Identifier NCT02320799.

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  • A randomized controlled trial in Kenya among HIV-positive women affected by gender-based violence reported support for both the content and structure of a group interpersonal psychotherapy intervention, as well as its feasibility.

    “There is additional evidence that supports efficacy among GBV survivors—an RCT in Kenya among HIV-positive women affected by GBV reported support for both the content and structure of a group IPT intervention, as well as its feasibility [42,43].”

    From Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations (2022) · cites this paper as [43]

    The Discussion (page unavailable) reports effective IPT for Kenyan HIV-positive women affected by GBV and says it could be feasibly integrated with HIV care, although the study met only two of four feasibility benchmarks. The Methods > Interventions (page unavailable) describe sessions with the same therapist treating each participant; the group sessions mentioned there were for therapist supervision, not patient psychotherapy. The paper does not report endorsement of a group intervention’s content and structure. (LLM, conf=0.88)

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Authors
Meffert, S. M., Neylan, T. C., McCulloch, C. E., Blum, K., Cohen, C. R., Bukusi, E. A., Verdeli, H., Markowitz, J. C., Kahn, J. G., Bukusi, D., Thirumurthy, H., Rota, G., Rota, R., Oketch, G., Opiyo, E., & Ongeri, L.
Affiliations
  • University of California, San Francisco (US)
  • San Francisco VA Medical Center (US)
  • University of Washington (US)
  • Columbia University (US)
  • University of Nairobi (KE)
  • University of Pennsylvania (US)
  • Kenya Medical Research Institute (KE)
Corresponding author
Meffert, Susan M.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2021-01-11
Volume
18
Issue
1
Pages
e1003468
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1003468
PMC
PMC7799784
OpenAlex
W3118656607
Cited by
67
References
47
Citations by year
2026: 10 · 2025: 14 · 2024: 9 · 2023: 16 · 2022: 13 · 2021: 5
FWCI
5.92
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • Greater South Information System
Funders
National Institute of Mental Health (K23MH098767)
Topics
  • Social Sciences › Health › Intimate Partner and Family Violence
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
interpersonal psychotherapy, depression, post-traumatic stress disorder, gender-based violence, intimate partner violence, women living with HIV, major depressive disorder, PTSD comorbidity, disability, absenteeism, Kenya, sub-Saharan Africa, access to mental health care, treatment discontinuation
MeSH terms
Gender-Based Violence, Interpersonal Psychotherapy, Adult, Major Depressive Disorder, Female, HIV Seropositivity, Humans, Kenya, Stress Disorders, Post-Traumatic

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