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