WE-ACTx is the recipient of a 5 year NIH National Institute of Child Health and Development grant entitled “Improving Adherence to Treatment Regimens for HIV-Positive Adolescents and Young Adults.”
As is true in most of sub-Saharan Africa, Rwandan youth are the global epicenter of the AIDS epidemic, accounting for 40% of new infections. While adults in Rwanda report good levels of adherence, studies of adolescents are less encouraging. In our preliminary research, youth reported logistical obstacles (e.g. no confidential place to store medicines), negative attitudes (e.g., not believing they need medications), mental health problems (e.g. hopelessness, depression, trauma), rigid gender-roles (gender-based violence), and unsupportive caregiver attitudes as the primary reasons for non-adherence.
The newly funded Youth Adherence study will be led by a highly experienced, multidisciplinary team including Dr. Mardge Cohen, WE-ACTx Medical Director, Dr. Sabin Nsanzimana, Rwandan Biomedical Center (RBC), under the Minister of Health, and Dr. Geri Donnenberg, Associate Dean of Research, School of Public Health and Professor of Psychology in Psychiatry at University of Illinois, Chicago.
We will use a 2-arm Randomized Control Trial to test and compare the efficacy of adherence-enhanced Trauma Informed-Cognitive Behavioral Therapy to usual care in increasing ART adherence among 350 Rwandan 14 – 21 year olds from the two clinics caring for the largest number of youth with HIV in Rwanda. Based on the Indigenous Leader Outreach Model, we will train 20 HIV+ indigenous youth leaders (IYL) and supervising psychologists to deliver the intervention.
The study answers a compelling need for innovative programs to increase ART adherence among HIV+ youth and will be the first empirically based intervention to improve adherence among youth in Rwanda. If effective, the study will build Rwanda’s capacity to provide much needed services; and, involvement by the Rwanda Biomedical Center will ensure wide dissemination.