Browsing by Author "Figge C"

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Effectiveness of trauma-focused cognitive behavioral therapy compared to psychosocial counseling in reducing HIV risk behaviors, substance use, and mental health problems among orphans and vulnerable children in Zambia: a community-based randomized controlled trial.
(2024-Jan) Kane JC; Figge C; Paniagua-Avila A; Michaels-Strasser S; Akiba C; Mwenge M; Munthali S; Bolton P; Skavenski S; Paul R; Simenda F; Whetten K; Cohen J; Metz K; Murray LK; School of Medicine, University of Zambia, University Teaching Hospital, Lusaka, Zambia.; Zambia Ministry of Health, Lusaka, Zambia.; Drexel University College of Medicine, Allegheny Health Network/Allegheny General Hospital, Pittsburgh, PA, USA.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Duke Global Health Instittute, Durham, NC, USA.; Department of Health Behavior, University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jk4397@cumc.columbia.edu.; Center for Health Policy and Inequalities Research, Durham, NC, USA.; Duke Sanford School of Public Policy, Durham, NC, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.; ICAP, Columbia University Mailman School of Public Health, New York, NY, USA.; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. jk4397@cumc.columbia.edu.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Orphans and vulnerable children (OVC) in sub-Saharan Africa are at high risk for HIV infection and transmission. HIV prevention and treatment efforts with OVC are hindered by mental health and substance use problems. This randomized controlled trial compared a mental health intervention, Trauma Focused Cognitive Behavioral Therapy (TF-CBT), to an enhanced version of an existing HIV Psychosocial Counseling (PC+) program among 610 adolescents who met PEPFAR criteria for OVC and had HIV risk behaviors in Lusaka, Zambia. Outcomes included HIV risk behaviors (e.g., risky sexual behaviors), mental health (internalizing symptoms, externalizing behaviors, PTSD) and substance use. At 12-month follow-up, there were significant within group reductions in both groups for all outcomes, with the only significant between group difference being for substance use, in which OVC who received TF-CBT had significantly greater reductions than OVC who received PC+. In a subgroup analysis of OVC with high levels of PTSD symptoms, TF-CBT was superior to PC + in reducing internalizing symptoms, functional impairment, and substance use. Findings support TF-CBT for reducing substance use among OVC. Subgroup analysis results suggest that a robust intervention such as TF-CBT is warranted for OVC with significant mental and behavioral health comorbidities. The similar performance of TF-CBT and PC + in the overall sample for risky sexual behavior and mild mental health problems indicates that enhancing existing psychosocial programs, such as PC, with standard implementation factors like having a defined training and supervision schedule (as was done to create PC+) may improve the efficacy of HIV risk reduction efforts.Clinical Trials Number: NCT02054780.
Telemedicine for unhealthy alcohol use in adults living with HIV in Alabama using common elements treatment approach: A hybrid clinical efficacy-implementation trial protocol.
(2023-Jun) Gagnon KW; Levy S; Figge C; Wolford Clevenger C; Murray L; Kane JC; Bosomprah S; Sharma A; Nghiem VTH; Chitambi C; Vinikoor M; Eaton E; Cropsey K; School of Public Health, Columbia University, New York, NY, USA.; School of Public Health, Johns Hopkins University, Baltimore, MD, USA.; London School of Hygiene and Tropical Medicine, University of London, London, UK.; School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Unhealthy alcohol use is an unaddressed barrier to achieving and maintaining control of the human immunodeficiency virus (HIV) epidemic. Integrated screening, treatment of common behavioral and mental health comorbidities, and telemedicine can improve alcohol treatment and HIV clinical and quality of life outcomes for rural and underserved populations. OBJECTIVE: In a randomized controlled clinical trial, we will evaluate the effectiveness and implementation of telephone-delivered Common Elements Treatment Approach (T-CETA), a transdiagnostic cognitive behavioral therapy protocol, on unhealthy alcohol use, HIV, other substance use and mental health outcomes among predominantly rural adults with HIV receiving care at community clinics in Alabama. METHODS: Adults with HIV receiving care at four selected community clinics in Alabama will receive a telephone-delivered alcohol brief intervention (BI), and then be assigned at random (stratified by clinic and sex) to no further intervention or T-CETA. Participants will be recruited after screening positively for unhealthy alcohol use or when referred by a provider. The target sample size is 308. The primary outcome will be change in the Alcohol Use Disorder Identification Test (AUDIT) at six- and 12-months post-enrollment. Additional outcomes include HIV (retention in care and viral suppression), patient-reported mental health (anxiety, depression, posttraumatic stress), and quality of life. A range of implementation measures be evaluated including T-CETA provider and client acceptability, feasibility, cost and cost-effectiveness. CONCLUSIONS: This trial will inform alcohol treatment within HIV care programs, including the need to consider comorbidities, and the potential impact of alcohol interventions on HIV and quality of life outcomes.