Olley BO.Improving Well-Being Through Psycho-Education Among Voluntary Counseling and Testing Seekers in Nigeria: A Controlled Outcome Study. AIDS Care 2006 Nov;18(8):1025-31.
To evaluate the efficacy of an individualized psycho-education (PE) program in reducing psychological distress and risky sexual behavior and enhancing self-disclosure of HIV infection among attendees of a voluntary counseling and testing (VCT) center in Nigeria who were found to be HIV-infected.
The study was a controlled clinical trial, in which 67 adult HIV-infected individuals were recruited from 94 individuals who came in for VCT services over a three-month period at a community and private walk-in VCT center in Abuja. The 67 individuals were consecutively assigned to two groups: 34 were assigned to psycho-education (PE) and 33 were assigned to an attention-placebo control wait list (WL) group. The final sample consisted of 62 participants; two patients dropped out of the PE group and three dropped out of the WL group.
VCT center in Abuja, Nigeria.
Of the 62 participants, 57% were female; the average age was 28 years; the mean level of education was 12 years; and 48% had never married. Twenty-two patients in the PE group and 19 in the WL group were unemployed. All the VCT seekers were self-referred and had not received any VCT prior to the study. None had received professional counseling or psychiatric treatment prior to the present intervention.
All VCT seekers (n=94) were given pre-test counseling by trained counselors. After informed and written consent was obtained, blood samples were taken and tested for HIV. The clients had to pay for the test. Test results were given the same day, at which time HIV-positive individuals were given post-test counseling, emotional support detailing the implication of the results, and the need for weekly support and a follow up for four weeks. HIV-negative individuals received counseling on preventive measures and the importance of repeat testing in 3 months. The PE group received a total of four one-hour manual-driven sessions of individual PE therapy conducted weekly. The intervention provided dyadic instruction focusing primarily on the cause and course of HIV/AIDS, its psychosocial impact, and self-management skills. The WL group also received a total of four one-hour sessions of individualized discussion that were mainly supportive in nature and not manual-driven.
The primary outcomes were determined using a variety of research instruments. The Beck Depression Inventory (BDI) was used for the assessment of a stable-trait-like property of depression. The Crown Crisp Experiential Index (CCEI) was used for the screening of generalized anxiety disorder with an overall score for emotionality or neuroticism and with further sub-scores in six clinical subscales (anxiety, phobic anxiety, obsessionality, somatic concomitants of anxiety, depression, and hysterical anxiety). A 20-item sexual-risk behavior scale was used to assess sexual activities in the six months prior to VCT. Intentions to disclose HIV infection to spouse, neighbors, colleagues, siblings, parents, and children were also measured. The Brief COPE, a 14-scale questionnaire, was used to assess coping behaviors.
Compared to the WL control group, the PE group showed a significant decrease in depression scores (p<0.01), a significant decrease in the aggregate score of neurotic disorders (p<0.01), and a significant increase in safe-sex practices (p<0.00) and self-disclosure (p<0.05) of HIV status to significant others at four-week follow up. With the exception of humor and religion, significant differences were found in the coping styles between the PE group and the WL group from pre-assessment to four-week follow-up. Within the PE group there was a significant decrease in BDI depression scores from baseline to four weeks post-assessment (p<0.001). The CCEI measures also indicate a significant decrease on all measures of neurotic disorders (p<0.001) from pre- to the four weeks post-assessment.
The authors conclude that their manual-driven PE program was effective in increasing HIV self-disclosure, reducing depression, and improving safe sexual practices.
Based on the Jadad grading system, this study was of adequate quality. The participants were randomized in a consecutive manner, which is not the best form of randomization. There is no discussion of the blinding of participants and staff. Five (7%) participants dropped out of the study after randomization, but this was non-differential. Another limitation of the study was the highly selective nature of the study participants. For instance, the participants were self-referred and may represent the most motivated testers. Additionally, the participants were selected from a private VCT center where patients had to pay for their tests, thus eliminating individuals who attend public clinics and possibly representing a different demographic. Lastly, there is always the possibility that the decrease in depression scores and psycho-neurotic symptoms within four weeks may actually be an artifact of repeated assessment rather than actual prevalence.
The results of this study support previously documented treatment effects of the use of psychological intervention in improving health conditions among HIV/AIDS patients in general, (1,2,3) and particularly its effects in reducing emotional, as well as social, distresses associated with notification of HIV infection.(4,5) Similar to other studies (6,7,8,9,10) that found psychological interventions to be effective in decreasing unsafe sexual behavior, this current study consistently found a reduction of risky sexual practices from the baseline assessment to four-weeks follow up in the PE group.
A manual-driven psycho-education program, such as the one used in this study, could provide short-term and effective therapy for psychopathology associated with HIV/AIDS diagnosis and a model of intervention for HIV/AIDS prevention at the community level. However, no long-term assessment of study results has been conducted to determine the durability of such a PE program.
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