1. Improvement in post traumatic stress & depressive symptoms in HIV-infected Rwandan women on antiretroviral therapy Mardge H. Cohen, Mary Fabri, Xiaotao Cai, Agnes Binagwaho, Qiuhu Shi, Kathryn Anastos Rwandan Women’s Interassociation Sudy and Assement (RWISA)

2. Methods
RWISA, a prospective observational cohort study of effectiveness and toxicity of ART in women, including survivors of genocidal rape, enrolled 710 HIV-infected and 226 uninfected women in At 6 month study visits, interviewers collect medical & psychosocial data to assess HIV disease progression and ART use
Trained research staff administered the Harvard Trauma Questionnaire (HTQ) and Center for Epidemiologic Studies Depression Scale (CES-D). Participants with PTSD scores > 2 and CES-D scores >=16 were considered to have PTSD and depressive symptoms.
Trained trauma counselors provide support for participants as needed.

3. Results % HIV+ women on ART Baseline CESD and PTSD scores HIV- HIV+
CES-D Mean < 0.001
> <0.001
>
PTSD Mean
>2 64% 57% 0.099
% HIV+ women on ART
Visit %
Change in Rate of PTSD and Depressive Symptoms Visit 1-4 in RWISA
Depressive Symptoms
PTSD Symptoms
Visit

4. Predictors of Reduced CESD and PTSD scores from Visit 1 to Visit 4*
For the whole cohort
--HIV was the only significant predictor for reduced CESD scores
--Uninfected women and women with more traumatic events had significantly greater reductions in PTSD scores from visits 1 to 4.
For HIV infected women
-- those with lower CD4 cell counts were more likely to have more reductions in CESD and PTSD scores.
--Those experiencing genocidal rape had greater reductions in PTSD scores.
-- ART was not a significant predictor of reduced scores.
*Controlling for age, marriage, HIV status, education, rape status during genocide, & trauma events, we used mixed models to solve for fixed effects using CESD and PSTD as the dependent variable.

5. Conclusions
Providing a safe, understanding, and helpful community of care reduces PTSD and depression symptoms, though depression symptoms are more persistent.
Administration of HTQ and access to trauma counselors provided a therapeutic environment
Structured interviews gave women opportunity to tell their trauma stories and impact of that experience was greater in those with more trauma events/severe trauma.
Although depressive symptoms and PTSD were reduced over 18 months, especially in women with HIV and those with a history of rape and more traumatic events, these conditions remained prominent among the entire cohort.
One out of two women at visit 4 still reported depressive symptoms and almost one of four reported PTSD symptoms.
Clinical care settings should address these conditions to reduce morbidity among women with HIV.