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

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 sampleControlInterventionComparison ‘P” Age 15.7 (1.5) P=0.695 Gender M n=24,F n=24M n=12, F n=12 P=1.0 Number of household mean (SD)6.0 (4.2)5.86.3P=0.703 CD (213.8) P=0.005* Brief Symptom Inventory (BSI) P=0.021 Rosenberg Self Esteem Scale (SES) P=0.472 Strengths and Difficulties Questionnaire (SDQ) Hyperactivity scale P=0.658 Emotional scale P=0.170 Conduct scale P=0.927 Peer problems P=0.835 Prosocial P=0.276 Total difficulties P=0.535 Self Efficacy Questionnaire (SEQ) Social scale P=0.857 Emotional scale 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 toolsT1T2 P=B Value (95% CI) P=B Value CI Brief Symptom Inventory (BSI) 0.001* (25.5, 64.4)0.001* (21.541, ) Rosenburg Self-Esteem Scale (SES) (-4.292,0448) 0.001*-9.007( , ) 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* (-8.161, ) , (-9.434, * ( , ) ( ,-5.983)

Results: mechanisms of action All 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