A PILOT RANDOMIZED CONTROLLED TRIAL TESTING EFFECTIVENESS OF MEMORY WORK THERAPY (MWT) FOR HIV-POSITIVE ORPHANED CHILDREN

Elvis Joseph Miti MPH

Dr. Richard Harding

Background Studies indicate many orphaned children have to face a lot of psychosocial

and high morbidity connected to their lose of parents or caregivers. (Harding & Sherr 2010).

To help those orphans build resilience is such circumstances, there are many organizations in Africa that are trying help those children.

PASADA provides Memory Work therapy (Corr et al. 2010) orphans on ART The challenge however is that no substantial evaluation had been done to

check and balance how those children benefit from Memory Work therapy (Repssi)

Since PASADA has been providing Memory Work therapy to 2 groups of children every year since 2006, there was an opportunity for an ethical “natural experimental and wait-list groups” for a Random Controlled Trial (RCT) Phase II .

The trial therefore provided the much needed information since there has been almost no papers or reports focused on care for orphans (Harding & Sherr 2010).

Aim and objectives Aim

The trial was aimed at determining whether Memory Work therapy 1 week group intervention improved the outcome for fully orphaned children (complex population) on ART treatment, in terms of their self esteem, coping and psychosocial wellbeing compared to standard care

Objectives1. To measure psychosocial well being (i.e. needs) of orphans on

AIDS treatment before attending the MWT2. To evaluate the groups in terms of outcome compared to existing

standard care (without MWT)3. To investigate the use of copying skills learnt in MWT seminars at

PASADA

Method• This was a Random Controlled Trial (RCT) Phase II • Ethical approval from HPCA and NMRT• Following (T0) baseline interviews, random allocation was for either intervention

Experimental Condition (EC), or Control Condition (CC). • All participated in second round of data collection (T1) at two weeks, and a final (T2) a

month later• The CC then received the intervention 4 months later before they and caregivers

participated in a Focus Groups a week after.• 4 questionnaires used, 1. Brief Symptom Inventory (BSI) 2. Rosenberg Self Esteem Scale (SES)3. Strengths and Difficulties Questionnaire (SDQ)4. Self Efficacy Questionnaire (SEQ)• Groups were compared at each time-point using multivariable linear regression controlling

for baseline characteristics and group as independent variable, with change score as dependent variable.

• Qualitative data were subjected to thematic analysis to describe the experience of the intervention and how to refine it

 Intervention: Memory work Group therapy

• We used Repssi manuals • The intervention was done by qualified PSS health care providers from

PASADA• Each residential therapy took 5 days • The children went through basic Memory work therapy that included the

following:

1. Making Memory box,

2. Making Memory book,

3. Tree of life and the Hero (Active Citizen) book• The materials that were used included used card boxes, colour pencils,

water colours and brushes, A4 white papers, A4 assorted colour manila papers, hammers, nails, cotton wool threads, glue, seal tape and flip charts.

• All those materials are locally obtainable from Stationaries and hardware shops

 Results: T0 Sample Characteristics

 

Whole sample Control Intervention Comparison ‘P”

Age 15.7 (1.5) 15.8 15.6 P=0.695

Gender M n=24 ,F n=24 M n=12, F n=12 M n=12,F n=12 P=1.0

Number of household mean (SD) 6.0 (4.2) 5.8 6.3 P=0.703

CD4 382.3 (213.8) 298.3 466.3 P=0.005*

Brief Symptom Inventory (BSI) 78.7 93.9 63.4 P=0.021

Rosenberg Self Esteem Scale (SES)

12.4 12.1 12.8 P=0.472

Strengths and Difficulties Questionnaire (SDQ)

Hyperactivity scale 3.4 3.2 3.5 P=0.658

Emotional scale 4.2 4.6 3.7 P=0.170

Conduct scale 3.4 3.2 3.4 P=0.927

Peer problems 3.6 3.6 3.5 P=0.835

Prosocial 7.8 7.6 8.1 P=0.276

Total difficulties 14.5 14.9 14.0 P=0.535

Self Efficacy Questionnaire (SEQ)

Social scale 25.1 25.25 25.0 P=0.857

Emotional scale 21.4 22.0 21.0 P=0.389

Results: Change overtime 

• We now present the results of outcomes for each measure and time point

• We used linear regression• We controlled for CD4 (and baseline score for

BSI) and group as independent variable

Results: Change Overtime Measuring tools T1 T2

P= B Value(95% CI)

P= B Value CI

Brief Symptom Inventory (BSI)

0.001* 44.985 (25.5, 64.4) 0.001* 46.668 (21.541, 71.835)

Rosenburg Self-Esteem Scale (SES).

0.109 -1.922 (-4.292,0448)

0.001* -9.007(-12.032, -5.983)

Goodman’s Strength and Difficulties Questionnaire (SDQ)

0.010* 4.811 (1.226, 8.396) 0.002* 5.218(1.960, 8.476)

Self-Efficacy Questionnaire for Children (SEQ) 14-Item Likert scale

Social scale

Emotional

0.015*

0.002*

-4.539(-8.161, -0.918)

-5.803, (-9.434, -2.171

0.001*

0.001*

-7.791 (-11.320, -4.262)

-9.007 (-12.032,-5.983)

Results: mechanisms of actionAll the children found the group very helpful and gave different reasons. As much as MWT is meant to be beneficial to the participants, the children, however, give some personal and specific benefits because of taking part in MWT. This included the realization of the importance of their caregivers, how living with AIDS is so much a challenge than a problem, MWT is a support group and a source of self-esteem.

• “I now understand how I could better live with my aunt and be a better child. I also would like to appreciate the support that I have received from my friends and the facilitators. My friends helped me understand how I am loved so much despite my HIV and AIDS status”. 4

• “I have learnt that living with HIV and AIDS is manageable and there are a lot of people in my family who are very helpful”. 19

Conclusion• We were are able to recruit and retain and strong effects in this

small group.

• The effect was not lost over time (i.e. at 4 weeks after intervention)

• The effect for self esteem appeared at T2, suggesting a process

• It necessary to measure Memory work therapy in a larger scale

fully powered trial

• We now have the data to design a full trial

• It is therefore very important to see how other organizations

should take advantage of evaluating their adolescent interventions

of Psychosocial in HIV and AIDS.

 Acknowledgments:

• We acknowledge the contribution of different people who enabled this study in one way or

another .Special thanks to all including the following

• All the children and their care for consenting to participate in the trial

• Staff of PASADA and UZIMA PROJECT for their support during and after this study in Medical and

Most Vulnerable Children’s departments

• Palliative Care Unit of the University of Cape Town especially Dr. Liz Gwyther and Dr. Richard

Harding for the directions

• Thanks to Dr. Lorriane Sherr for her contributions on the measuring tools

• Repssi for the different manuals and documentation used in this intervention

• Special thanks to all the organizers of AIDS-Impact for giving us this opportunity to present those

findings