Group-based Self-Help Plus, Problem Management Plus and pre-exposure prophylaxis to improve mental health and reduce HIV risk in survivors of rape in KwaZulu-Natal, South Africa: A pilot and feasabilty randomised study

Abstract

Introduction

Gender-based violence (GBV) and HIV are highly prevalent in South Africa and are significant public health problems. Rape is a risk factor for both HIV acquisition and adverse mental health outcomes. Post-rape interventions targeting HIV and mental health are needed to mitigate risk and aid recovery.

Methods

Self-Help Plus (SH+) and Problem Management Plus (PM+) are lay counsellor-facilitated, group-based mental health interventions. We adapted them for KwaZulu-Natal, South Africa and translated them into isiZulu. 106 women who had been raped were randomized, in groups of 8–10, to a post-rape mental health intervention group (RI) or to a rape-survivor waitlisted control (RC) group. Additionally, we included an intimate partner violence shelter intervention (SI) group (n = 38). All participants completed questionnaires at baseline, 3- and 6-months. The intervention groups completed SH+ and PM+ in the first 3 months after completing the baseline assessment. All HIV-negative women were offered once daily, oral Truvada as Pre-Exposure Prophylaxis (PrEP) for HIV.

Results

The RI group showed a significant decline in depression at 3-months (β = −5.41, p = 0.017) and at 6-months (β = −10.23, p = 0.005) compared to the RC group. The SI group showed a significant decline in PTSD scores at 6-months (β = −3.5, p = 0.031). Both groups, RI (β = −4.91, p = 0.026) and SI (β = −3.5, p = 0.026), showed a significant decline in symptoms of complex PTSD (i.e., disturbances in self organization) at 3-months. 65 % of eligible participants (n = 85) in all groups took up PrEP with relatively high adherence.

Conclusion

In this pilot and feasibility trial, SH+ and PM + show promise in reducing depression, PTSD and cPTSD scores over time in women after rape and IPV. PrEP uptake was favorable, suggesting that after rape, many women are open to long-term HIV prophylaxis with PrEP, however uptake can be improved with additional measures.