Understanding and Addressing Trauma and Violence in HIV Prevention and Treatment

July 16^th,  2020

Overview
Exposure to trauma and violence are associated with higher rates of HIV infection, as well as poorer HIV treatment outcomes. To date, there are few evidence-based interventions that address trauma or violence that have been shown to improve either HIV prevention or treatment outcomes. This session will focus on different intervention approaches that the speakers have utilized to address this gap in the literature. Presentations will be followed by a moderated discussion and a question and answer session.

Speakers

Laura K. Murray, M.A., Ph.D.
A transdiagnostic, de-siloed approach to addressing mental health within HIV care and treatment

Dr. Laura Murray is a Senior Scientist at Johns Hopkins University, School of Public Health in the Department of Mental Health and International Health, and a clinical psychologist by training. Dr. Murray has extensive expertise in a wide range of evidence-based treatments for mental and behavioral problems. She has conducted research ranging from qualitatively understanding mental health to full randomized trials of treatments focusing on low and middle-income countries globally such as Zambia, Democratic Republic of Congo, Ethiopia, Myanmar, Ukraine, Iraq, Cambodia, Papua New Guinea, and many others. Much of her work has focused on HIV-affected populations. Dr. Murray publishes extensively on global mental health in top journals, trains globally, regularly speaks at conferences and organizations, and consults with organizations to improve functioning through skills training on stress, resiliency, and leadership.

Conall O’Cleirigh, Ph.D.
Translating evidence-based treatments for those with traumatic lived experiences for use in global resource-limited settings

Dr. Conall O’Cleirigh is an Associate Professor in Psychology at Harvard Medical School and Director of the Behavioral Medicine Program in the Department of Psychiatry at Massachusetts General Hospital. He is a health clinical psychologist whose clinical work focuses on supporting patients with the management of acute and chronic medical illnesses. His clinical focus encompasses the treatment of post-traumatic stress, anxiety, and mood disorders and working specifically with sexual minorities and people living with HIV. Dr. O’Cleirigh is currently Principal Investigator of 5 NIH-funded R01 research grants, conducting primary and secondary HIV prevention and treatment behavioral research among people living with or at risk for HIV in both domestic and global settings in Zimbabwe, South Africa, and India. His principal area of expertise is adapting evidenced-based cognitive behavioral technologies for specific application to issues related to mental health and substance use vulnerabilities in the context of HIV prevention and treatment.

Linnet Ongeri, MBChB, M.Med (Psych)
Prevalence of trauma and related mental disorders in Kenya: A national review and local case example

Dr. Linnet Ongeri is a Senior Clinical Researcher at the Kenya Medical Research Institute, Centre for Clinical Research in Nairobi, Kenya, and a Kenyan psychiatrist. Dr. Ongeri’s research expertise is broad. She has explored suicidality and the prevalence of PTSD as a co-investigator in a large household survey in Western Kenya. She was principal investigator (PI) of a study on postpartum depression, which sought to establish the magnitude of late pregnancy and postpartum depression among women seeking care at maternal and child health clinics in Nairobi, and validated a postpartum depression screen in the local language. She has served as site-PI for an effectiveness-implementation hybrid type I study of Interpersonal Therapy (IPT) delivered by non-specialists for HIV-positive women facing gender-based violence in Kisumu County. As a trained IPT clinician, Dr. Ongeri trained and supervised lay health workers’ delivery of IPT for the study. She is now conducting a scale-up of the IPT intervention comparing the effectiveness and cost of delivery of IPT versus fluoxetine treatment for depression and PTSD by trained non-specialists. Aside from her research, Dr. Ongeri is engaged in policy work. She is a member of the Presidential Mental Health National Task Force and the Technical Working Group for Mental Health at the Ministry of Health. In this capacity, she has been involved in developing national guidelines, policy documents, and national reports on mental health in Kenya.

Susan M. Meffert, M.D., M.P.H.
Non-specialist delivery of HIV clinic-integrated, mental health treatment for depression and trauma-disorders among HIV-positive women affected by Gender-Based Violence in Kenya

Dr. Susan M. Meffert is an Associate Professor at the University of California, San Francisco (UCSF) Department of Psychiatry, and a UCSF Global Health Sciences Faculty Affiliate. Dr. Meffert has been working in global mental health since 1998. She began clinical research in 2004 during her psychiatric residency at UCSF, returning to East Africa to work with Darfur refugees. Since 2009, Dr. Meffert has been working in Kenya with Family AIDS Care Education and Services (FACES), a UCSF collaborative site in Kisumu County funded by PEPFAR. Within the FACES HIV-primary care platform, she and Kenyan collaborators conducted an effectiveness-implementation hybrid type I study of integrated mental health care for depression and trauma-disorders among HIV-positive women affected by gender-based violence that was delivered by non-specialists (n=261). Now funded by a joint Global Alliance for Chronic Disease (GACD)-NIMH award, she is a multiple principal investigator (MPI) for the Depression And Primary-care Partnership for Effectiveness-implementation Research (DAPPER) (R01 MH115512). DAPPER supports an effectiveness-implementation hybrid randomized study of psychotherapy versus pharmacological depression treatment (n=2,000) to evaluate non-specialist delivery of evidence-based care integrated within an existing public sector county healthcare center (Kisumu County Hospital) in regards to clinical effectiveness and implementation parameters. Dr. Meffert subsequently received an award (R01 MH113722, PI), which leverages the DAPPER study to add randomized, second line, non-specialist treatment for non-remitters with depression and/or post-traumatic stress disorder (PTSD), creating a sequential multiple assignment randomized trial (SMART-DAPPER, n=2,710).

Moderator:

Teri Senn, Ph.D.
Scientific Program Officer, NIMH Division of AIDS Research