Effectiveness of the Common Elements Treatment Approach (CETA) for mental and behavioral health outcomes among women struggling to remain adherent to HIV treatment and who have experienced intimate partner violence in South Africa: A randomised controlled trial

BackgroundRates of intimate partner violence (IPV) and HIV in South Africa are among the highest globally. IPV is associated with a range of adverse mental health and HIV outcomes. The Common Elements Treatment Approach (CETA) is a transdiagnostic, evidence-based intervention delivered by lay providers. ObjectiveTo compare the effectiveness of CETA to active attention control in reducing IPV, depression, Post-Traumatic Stress Disorder (PTSD), and substance use among women at risk of poor HIV outcomes who have experienced IPV. MethodsWomen living with HIV with an unsuppressed viral load or at risk for poor adherence and experienced past 12-month IPV were recruited from Johannesburg-area clinics and randomised 1:1 to CETA or control (SMS HIV appointment reminders plus safety checks and planning). The primary trial outcome was HIV retention and viral suppression, reported elsewhere. This paper reports secondary outcomes, evaluated at three and 12 months: IPV, depression, PTSD, and substance use. FindingsParticipants were enrolled between November 11, 2021 to July 19, 2023 and randomised to CETA (N=202) or control (N=197). In the intent to treat analysis, the Cohens d treatment effect for depression at three months was 0.24 (difference in mean change -3.1; 95% CI: -6.1, 0.1) and 0.48 at 12 months (-6.2; 95% CI: -9.5, -2.8). The PTSD treatment effect was 0.39 at three (-0.3; 95% CI: -0.5, -0.1) and 0.47 at 12 months (-0.3; 95% CI: -0.5, -0.2). Effect sizes were larger in a subgroup of participants with the top 50% of baseline symptom scores (depression: d=0.50, d=0.74; PTSD: d=0.58, d=0.94, at three and 12 months, respectively). There were no statistically significant differences in change for substance use or IPV. At baseline, only 12% of participants had past 3-month substance use and 32% had past 3-month or ongoing experiences of IPV, which made these outcomes challenging to evaluate. ConclusionsCETA was effective for reducing depression and PTSD including among high severity participants and at an extended follow-up. Future studies with increased power for substance use and IPV outcomes are warranted. Clinical implicationsCETA is a recommended treatment for depression and PTSD among this population. Trial registration numberClinicaltrials.gov NCT04242992, registered January 27, 2020 Key MessagesO_ST_ABSWhat is already known about this topic?C_ST_ABSIntimate partner violence (IPV) and related mental health problems are common in South Africa and can lead to poor HIV outcomes, such as low retention in care and viral non-suppression. There is a lack of evidence-based mental healthcare options for women living with HIV who have experienced IPV. What this study addsAmong women living with HIV and past-year IPV experiences, we found that Common Elements Treatment Approach (CETA) was an effective treatment for depression and PTSD compared to a control condition. How this study might affect research, practice, or policyCETA is recommended to treat common mental health problems among women with HIV and experiences of IPV.