BackgroundThere is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middle-income countries in sub-Saharan Africa. We validated the Shona version of the PTSD Checklist for DSM-5 (PCL-5) in a primary health care clinic in Harare, Zimbabwe.MethodAdults aged 18 and above attending the clinic were enrolled over a two-week period in June 2016. After obtaining written consent, trained research assistants administered the tool to eligible participants. Study participants were then interviewed independently using the Clinician Administered PTSD Scale (CAPS-5) as the gold standard by one of five doctors with training in mental health.ResultA total of 204 participants were assessed. Of these, 91 (44.6%) were HIV positive, 100 (49%) were HIV negative, while 13 (6.4%) did not know their HIV status. PTSD was diagnosed in 40 (19.6%) participants using the gold standard procedure. Using the PCL-5 cut-off of ≥33, sensitivity and specificity were 74.5% (95%CI: 60.4–85.7); 70.6% (95%CI: 62.7–77.7), respectively. The area under the ROC curve was 0.78 (95%CI: 0.72–0.83). The Shona version of the PCL-5 demonstrated good internal consistency (Cronbach’s alpha = 0.92).ConclusionThe PCL-5 performed well in this population with a high prevalence of HIV. There is need to explore ways of integrating screening tools for PTSD in interventions delivered by lay health workers in low and middle-income countries (LMIC).

Children and youth affected by AIDS typically face a wide range of stressful events and circumstances, including poverty, the loss of caregivers and loved ones, having to drop out of school, the burden of adultlike responsibilities, and social isolation. Increasingly programs for orphans and vulnerable children are addressing not only their material and educational needs, but their psychosocial needs as well. Yet there has been little research on how to evaluate psychosocial support (PSS) programs and the impact of these programs on vulnerable youth's psychosocial well-being. This report presents findings from an exploratory study by the Regional Psychosocial Support Initiative (REPSSI) and Catholic Relief Services' Support to Replicable, Innovative Village/Community-level Efforts (STRIVE) Program of vulnerable youth living in and around Bulawayo, Zimbabwe. It describes their demographic characteristics, exposure to stress and trauma, and psychosocial well-being. The report also highlights the relationships between psychosocial well-being outcomes and exposure to stress and trauma, and the differences in psychosocial well-being between males and females, orphaned and nonorphaned youth, and younger and older adolescents. In addition, the report explores the relationships between exposure to different psychosocial support programs and measures of psychosocial well-being and distress. The report concludes with program and research implications. Methods First, formative qualitative research was conducted with youth and adults working with youth to determine local concepts, manifestations, and domains of well-being among youth. These findings, together with input from local youth and international research experts and psychologists, were used to draft a quantitative survey. After pre-testing and finalizing the survey, the researchers administered it to a cross-sectional sample of 1,258 orphans and vulnerable youth, ages 14 to 20. All of the youth fell into one of three intervention groups, or into a fourth comparison group. The intervention groups included (1) youth exposed to community PSS, (2) youth exposed to the Salvation Army Masiye Camp, a residential PSS program, and (3) youth who attended Masiye Camp and went on to become youth peer leaders. Youth in the comparison group had not been exposed to any known PSS program. Data analysis was conducted in three stages to: (1) produce a profile of the sample, (2) determine relationships between psychosocial measures and demographic characteristics of the sample, and (3) explore associations between participation by youth in PSS interventions and psychosocial outcomes. The cross-sectional design of the study does not allow for establishing a causal relationship between program exposure and psychosocial well-being measures. But, using multiple regression analysis, the researchers were able to explore differences in select psychosocial well-being variables (e.g., self-Despite widespread trauma, daily stress, and psychosocial distress, many youth maintained selfconfidence,...

Background: We investigated the prevalence of and factors associated with post-traumatic stress disorder (PTSD) and common mental disorders (CMDs), which include depression and anxiety disorders, in a setting with a prevalence of high human immunodeficiency virus (HIV) within a primary care clinic, using the PTSD Checklist for DSM-5 and the 14-item Shona Symptom Questionnaire, both locally validated screening tools.Methods: A cross-sectional survey was carried out with adult patients (n = 204) from the largest primary care clinic facility in Harare, Zimbabwe, in June 2016.Results: A total of 83 patients (40.7%) met the criteria for probable PTSD, of whom 57 (69.5%) had comorbid CMDs. Among people living with HIV, 42 (55.3%) had PTSD. Probable PTSD was associated with having experienced a negative life event in the past 6 months [adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.49–9.34] or screening positive for one or more CMD (adjusted OR 6.48, 95% CI 3.35–2.54).Conclusion: People living with HIV showed a high prevalence of PTSD and CMD comorbidity. PTSD screening should be considered when the CMD screen is positive and there is a history of negative life events.

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This study investigated the experience of lay health workers (LHWs) delivering problem-solving therapy (PST) for common mental disorders (CMD) as well as clients’ views of the PST program referred to as the Friendship Bench (FB). Semi-structured interviews were conducted with LHWs (n = 5) and clients living with HIV (PLWH) (n = 10). Data were analyzed using thematic content analysis. LHWs described a severe form of CMD amongst PLWH with a history of trauma, naming it kufungisisa kwe njodzi (excessive thinking due to trauma), a local cultural equivalent of PTSD. The term kufungisisa (thinking too much) has been used as the local equivalent for CMD. Trauma or njodzi was seen both as a circumscribed event and as linked to ongoing pervasive experiences such as living with HIV, stigma, and poverty. Although LHWs recognized symptoms of PTSD such as intrusion, avoidance, and hyper-arousal, they did not know how to address these specifically and chose to address them as a severe form of kufungisisa. There is a need to integrate aspects of PTSD management within care packages for CMD delivered by LHWs.