Research Projects

Active Projects

Improving the Health of South African Women with Traumatic Stress in HIV Care

PI: Kathleen J. Sikkema
Co-PI: John Joska (University of Cape Town)
Funder: NIMH, R34, 2014-2017
Site: Cape Town, South Africa
 

Center for AIDS Research (CFAR), Social and Behavioral Sciences Core

Core Director: Kathleen J. Sikkema
Funder: NIAID, P30, 2010-2015
Site: Duke University
 

Alcohol Related HIV Risks among South African Women 

PIs:  Kathleen J. Sikkema and Seth Kalichman (Univ. Connecticut)
Funder: NIAAA, R01, 2008-2014
Site: Cape Town, South Africa 
 

Studying Obstetric Fistula and Trauma in Moshi, Tanzania

PI:  Kathleen J. Sikkema
Funder: Gender Poverty and Health Working Group, 2010-2012
Site: KCMC in Moshi, Tanzania
 

Positive Choices: Brief Care-Based HIV Prevention for Newly Diagnosed Men

PI:  Kathleen J. Sikkema 
Funder: NIMH, R01, 2009-2012
Site: NY, Callen Lorde Community Health Center

 

Completed Projects

Coping Intervention for HIV Infected Older Adults (50+)

Co-PIs:  Kathleen J. Sikkema and Tim Heckman (Ohio Univ.)
Funder: NIMH, R01, 2004-2008
Site: NY, Callen Lorde

Developing Culturally Appropriate Counseling for South African Youth in HIV Vaccine Trials

PIs:  Glenda Gray (Witwatersrand) and Kathleen J. Sikkema
Funder: NIMH, R21, 2008-2011
Site: Johannesburg, South Africa
 
PI:  Brian Forsyth (Yale)
Funder: NIMH, R01, 2005-2011
Site: Pretoria, South Africa
 

Intervention for Coping with HIV and Trauma (LIFT: Living in the Face of Trauma) 

PI:  Kathleen J. Sikkema
Funder: NIMH, R01, 2000-2005
Site: NY, Callen Lorde
 

HIV Prevention Among Abused Women in South Africa 

PI:  Kathleen J. Sikkema
Funder: World AIDS Foundation (WAF), 2002-2004
Site: Johannesburg, South Africa
 

Teen Health Project

PI: Kathleen J. Sikkema and Jeffrey Kelly
Funder: NIMH, R01, 1997-2000
Site: United States

Intervention for Coping with AIDS-related Bereavement (Living Beyond Loss)

PI:  Kathleen J. Sikkema
Funder: NIMH, R01, 1996-2001
Site: Milwaukee and New York
 
 

Project Descriptions

Active Projects

Improving the Health of South African Women with Traumatic Stress in HIV Care

PI: Kathleen J. Sikkema, John Joska (Co-PI University of Cape Town)

Funder: NIMH, R34, 2014-2017

Site: Cape Town, South Africa

The primary purpose of this project is to develop Improving AIDS Care after Trauma (ImpACT), an intervention based on theories of stress, coping, and evidence-based treatment for traumatic stress. In the first phase of this three year study, we will develop a brief and scalable coping intervention for delivery in the South African HIV care setting for women with sexual trauma histories to reduce avoidant coping and traumatic stress. During the second phase of the study, we will establish the methodological details of an experimental protocol for a robust RCT to test the ImpACT intervention. A pilot test of the ImpACT intervention with 60 HIV-infected women with histories of sexual trauma who are initiating ART will occur in the third phase. This intervention has the potential to improve care engagement and retention, improve ART adherence, reduce risk behaviors, and therefore prevent HIV transmission within the target population.

Center for AIDS Research (CFAR), Social and Behavioral Sciences Core

Core Director: Kathleen J. Sikkema
 
Funder: NIAID, P30, 2010-2015
 
Site: Duke University
 
The Social and Behavioral Sciences (SBS) Core aims to support interdisciplinary resaerch on the social and behavioral determinants of HIV-related outcomes to prevent new infections, to develop innovative interventions, and to support improvements in quality of life for people living with HIV. To accomplish this misson, the SBS core provides several services including scientific consultations, peer review, networking, mentoring, community engagement, dissemination of findings, and assistance with research in the Duke Infectious Disease Clinic. These services help to enhance the quality and quantity of SBS HIV/AIDS research that takes place at Duke University, builds the individual and collective capacity of Duke SBS researchers to produce relevant HIV research, increases the reach and impact of Duke SBS studies, and enhances the conduct of SBS research in the Duke Infectious Disease clinic.
 

Alcohol Related HIV Risks among South African Women 

PIs:  Kathleen J. Sikkema and Seth Kalichman (University of Connecticut)

Funder: NIAAA, R01, 2008-2014

Site: Cape Town, South Africa

This project was a multi-level prospective analysis of alcohol-related HIV risks among women who drink in alcohol serving establishments in Cape Town, South Africa. The analysis was grounded in Social Action Theory and incorporated factors derived from three levels of analysis: structural/environmental, social/interpersonal, and individual. The study centered around 12 drinking establishments (shebeens) in a township community consisting of Black Africans of Xhosa heritage and Coloureds (mixed race). Data was collected from key informants, alcohol serving business owners, managers and servers, qualitative interviews and cross-sectional surveys of men and women drinkers, and a prospective cohort of 540 women. Assessments were conducted at 4 time points: baseline, 4-, 8-, and 12-months. Data analysis examined the factors that influenced women’s alcohol-related HIV risks, including a focus on mental health issues. A list of publications from this study is available below. 

 
 

Studying Obstetric Fistula and Trauma in Moshi, Tanzania

PI:  Kathleen J. Sikkema

Funder: Gender Poverty and Health Working Group, 2010-2012

Site: KCMC in Moshi, Tanzania

The specific aims of the SOFT study were to: 1) develop reliable and valid instruments to measure psychological constructs in women with obstetric fistula, 2) compare psychological symptoms of women with fistula to similar women without fistula, 3) assess changes in psychological symptoms after surgical repair, 4) describe life experiences of women with obstetric fistula, and 5) identify potential mental health interventions for these women. These aims were achieved by applying a cross-disciplinary and mixed-methods approach that included adaption and validation of psychological measures; a survey of 40 women with fistula and 40 women without fistula; follow up interviews with 20 women after fistula repair surgery; and in-depth qualitative interviews with 20 obstetric fistula patients, including 10 repeat interviews post-repair. We found that when compared with gynecology outpatients on a number of psychosocial outcomes, obstetric fistula patients reported higher symptoms of depression, PTSD, somatic complaints, and maladaptive coping, as well as lower social support. The results also suggested that evidence-based treatment for psychological disorders should be integrated into treatment of obstetric fistula patients. The results were shared in a community forum as part of a process to identify components of an intervention to mitigate the negative psychological effects of living with fistulae. Pilot data were used to support an R21 to develop an intervention to address this issue: "Development of Mental Health Treatment for Obstetric Fistula Patients in Tanzania."

Positive Choices: Brief Care-Based HIV Prevention for Newly Diagnosed Men 

PI:  Kathleen J. Sikkema 

Funder: NIMH, R01, 2009-2012

Site: NY, Callen Lorde Community Health Center

The Positive Choices study evaluated the efficacy of a brief positive prevention intervention, based on the Information, Motivation and Behavioral Skills (IMB) Model, provided within the care and treatment of newly diagnosed HIV-positive men who have sex with men (MSM) to reduce transmission risk behavior. The two-year study randomly assigned 102 sexually active, HIV-positive MSM, newly diagnosed within the prior 3 months, to receive either 1) comprehensive standard of care (CSC) or 2) Brief Risk Reduction + CSC (BRR), a brief individual intervention based on the IMB model that addressed sexual transmission risk behavior and substance use.  BRR followed the initial physician visit and integrated risk reduction in the context of personalized and relevant medical treatment to enhance the uptake of health-protective information. Assessments of information, motivational influences, behavioral skills, sexual risk behavior, and substance use were collected at baseline, post-intervention (3-), and 6-, and 9- month follow-up points to determine intervention outcome effects. The Positive Choices intervention group significantly reduced the frequency of unprotected anal intercourse (UAI) with HIV negative or serostatus unknown partners over the 9-month follow-up period. A reduction of UAI occurred with both primary and secondary partners occurred at 3-months post-intervention, and the reduction in UAI with HIV negative or serostatus unknown partners.  These results provide evidence that brief risk intervention approaches for newly-diagnosed MSM integrated into HIV care can effectively reduce engagement in risky sexual behaviors that may increase the transmission of HIV.

 

Coping Intervention for HIV Infected Older Adults (50+) 

Co-PI:  Kathleen J. Sikkema and Tim Heckman (Ohio Univ.)
 
Funder: NIMH, 2004-2008
 
Site: NY, Callen Lorde
 

The 50+ study evaluated the impact of a face-to-face 12-session Coping Improvement Group Intervention (CI) on the adjustment efforts of HIV-infected persons 50+ years of age or older in comparison to either a face-to-face 12-session Information-Support Group Intervention (ISG) or Standard of Care condition. In the CI condition, the intervention was conducted in small groups of participants and utilized cognitive-behavioral principles to improve skills in stress appraisal, coping, and social support. In the ISG condition, participants discussed contemporary issues related to living with HIV/AIDS; however, this condition did not address stress appraisal or coping. In the Standard of Care condition, participants had access to customary HIV-related support services available in the community. It was hypothesized that participants in the CI group would report significant decreases in HIV-related life stressor burden, depressive symptoms, and other patterns of psychological distress, increases in life quality, and increases in perceptions of social support at post-intervention and follow-up assessment points in comparison to the other two conditions. In addition, it was expected that participants in the CI group would report more consistent adherence to HAART regimens relative to comparison group participants over the course of the study.   

 
 

Completed Projects

Intervention for Coping with HIV and Trauma (LIFT: Living in the Face of Trauma)

PI: Kathleen J. Sikkema

Funder: NIMH, 2000-2005

Site: NY, Callen Lorde

The LIFT study evaluated the efficacy of a secondary prevention intervention for people with HIV infection who are coping with traumatic stress related to sexual abuse. The overall goals for the intervention were to reduce psychiatric distress and increase health protective behaviors. Two hundred forty-seven men adn women with HIV infection who were sexually abused as children or adolescents were randomly assigned to an HIV and trauma coping group or a support group comparison condition. The coping intervention group was found to be the most efficacious in reducing traumatic stress, sexual transmission risk behaviors, and substance use over a 12-month follow up period.

The LIFT study was recognized by:

  • CDC Prevention Research Synthesis Best-Evidence Intervention; 2008
  • NREPP (National Registry of Evidence-Based PRograms and Practices); 2011
  • HAPPA (HIV/AIDS Prevention Program Archive, NIAID); 2010

The intervention manual is available upon request (kathleen.sikkema@duke.edu).

Developing Culturally Appropriate Counseling for South African Youth in HIV Vaccine Trials

PIs: Glenda Gray (Witwatersrand) and Kathleen J. Sikkema

Funder: NIMH, R21, 2008-2011

Site: Johannesburg, South Africa

The objective of this study was to adapt and pilot test a CDC risk reduction intervention model for appropriate use with adolescent (16-18 year olds) vaccine trial participants in South Africa. Data collected from adolescents on risk behaviors were used to culturally and developmentally adapt the existing risk reduction counseling recommended for HIV vaccine trial participants into an intervention model that was more appropriate for adolescent participation in vaccine trials. In Phase 2an ethnographic study of younger adolescents and pre-teens aged 9-15, their households and their social networks, was conducted for the development of a risk reduction counseling intervention that was considerate of the specific legal and ethical milieu within HIV vaccine trials. During the third phase of the study, we conducted a feasibility test of the modified risk reduction intervention model in order to assess acceptability for use in future HIV vaccine trials that include adolescent participation.

 

Promoting Resilience in Young Children of HIV-Infected Women in South Africa (Kgolo Mmogo) 

PI:  Brian Forsyth (Yale)

Funder: NIMH, R01, 2005-2011

Site: Pretoria, South Africa

Kgolo Mmogo aimed to: 1) Demonstrate the extent of psychosocial effects of parental HIV disease on young children, living in poor urban communities in South Africa, by comparing them to other children whose parents were not HIV-infected, but living in the same communities; 2) Assess the effectiveness of a theory-based group intervention for HIV-infected mothers and their children designed to improve maternal functioning and help mothers promote resilience in children at two different ages and stages of development -- very young children (aged three to five years) and school-aged children (ages six to ten years); and 3) Identify maternal psychological and medical factors (including initiation of antiretroviral treatment), and child-related mediating variables, that contribute to changes in the adaptive functioning of children of HIV-infected parents over a 24-month interval. HIV infected women who were attending clinics in Tshwane, South Africa and their children (6 – 10 years) were randomized to the intervention or standard of care. The intervention was comprised of 24 weekly group sessions, and both mothers and children completed assessments at baseline and 6-, 12-, and 18 months. Mothers enrolled in the intervention reported significant improvements in children’s externalizing behaviors, communication, and daily living skills. The results of this study demonstrate that a parent-child group intervention can be beneficial in promoting resilience among young children of HIV-infected mothers.

Intervention for Coping with AIDS-related Bereavement (Living Beyond Loss)

PI:  Kathleen J. Sikkema

Funder: NIMH, R01, 1996-2001

Site: Milwaukee and New York

The objectives of the Living Beyond Loss study were to evaluate the efficacy of an AIDS-related bereavement coping and cognitive-behavioral skills group intervention by: 1) Recruiting 235 men and women who met entry criteria indicative of AIDS-related bereavement and psychiatric distress, assessing each participant at the time of study entry with measures of psychological distress, grief reaction, social support, coping skills, and quality-of-life; 2) Randomly assigning, stratified by psychiatric diagnoses and use of psychotropic medications, one-half of the recruited participants to the AIDS-related bereavement cognitive coping and cognitive-behavioral skills group intervention and the others to a control condition; and 3) Determining whether participants in the AIDS-related bereavement cognitive coping and cognitive-behavioral skills group intervention differ from those assigned to the control condition.

 

HIV Prevention Among Abused Women in South Africa 

PI:  Kathleen J. Sikkema

Funder: World AIDS Foundation (WAF), 2002-2004

Site: Johannesburg, South Africa

The primary goals of the study, conducted in collaboration with the University of Pretoria and a Johannesburg NGO (POWA: People Opposing Women Abuse) were to conduct training in the design, implementation and evaluation of behavioral interventions to prevent HIV infection, and to pilot test an intervention to reduce HIV risk among women in Gauteng Province who have experienced relationship violence and sexual abuse (including rape). The overall goals for the intervention were to reduce HIV risk behaviors and reduce trauma-related stress. 

Teen Health Project

PI: Kathleen J. Sikkema and Jeffrey Kelly

Funder: NIMH, R01, 1997-2000

Site: United States

The Teen Health Project was a community level intervention to reduce the behavioral risk for contracting HIV among youth.  1172 adolescents ages 12-17 representing 15 housing developments throughout the United States were randomly assigned in equal numbers to each of the study conditions: experimental community-level intervention (five developments); ‘state-of-the-science’ skills training workshops (five developments); and, education-only delayed control intervention (five developments).   The community intervention included the ‘state of the science’ skills training followed by a multi-component community intervention: (1) follow-up sessions; (2) participation of opinion leaders in a Teen Health Project Leadership Council (THPLC); (3) THPLC-sponsored activities to create social and environmental supports for HIV risk avoidance; and, (4) HIV/AIDS workshops for parents. At follow-up, adolescents living in the housing developments receiving the community-level intervention were more likely to delay onset of first Intercourse and use a condom at last intercourse than those in the control developments.

The intervention was selected as an effective program by the Office of Adolescent Health in the Department of Health and Human Services and is listed in the Program Archive on Sexuality, Health and Adolescence (NICHD).  The CDC Prevention Research Synthesis also selected the Teen Health Project as a Promising-Evidence Community Level Intervention. 
The intervention package is available from Sociometrics. 

 

Last updated 2/7/17