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HIV/AIDSCETANCT04242992

Effectiveness of Transdiagnostic Cognitive Behavioral Therapy for Improving HIV Treatment Outcomes in South Africa

A study testing CETA and Short Message Service (SMS) text reminders in people with HIV/AIDS and Violence, run by Boston University at 1 site in South Africa.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study will evaluate the impact of the Common Elements Treatment Approach (CETA), an evidence-based intervention comprised of cognitive-behavioral therapy elements, at improving HIV treatment outcomes among women with HIV who have experienced intimate partner violence (IPV) and have an unsuppressed viral load on… Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
HIV/AIDS, Violence
What is being tested?
CETA and Short Message Service (SMS) text reminders
Could I receive a placebo?
No, everyone receives an active treatment
How many people
399 participants
Where
1 siteSouth Africa
Study dates
12 Nov 2021to 23 May 2025
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Adult HIV positive women
  • Initiated HIV treatment
  • Most recent viral load >50 copies/mL or they have defaulted from treatment or had a missed or late (>14 days) visit in the last year
  • Has experienced IPV in the past 12 months
  • Has their own phone and can receive text messages
  • Literate and able to speak and read one of: English, Zulu, SeSotho
  • If including a partner, the woman has disclosed HIV status to the partner that will be invited to participate (noting that male partners are not study subjects, only the woman is)

Who cannot join

  • Unwilling to complete the informed consent process
  • Currently psychotic or on unstable psychiatric regimen
  • Suicide attempt/ideation with intent and plan, and/or self-harm in the past month
  • Enrolled in any other HIV treatment intervention study

Trial locations and contacts

1 site in 1 country.

South Africa1 site
  • HIV Clinic

    Johannesburg, Gauteng, 02476

Other trials in South Africa

About this study

Official title: Testing the Effectiveness of an Evidence-based Transdiagnostic Cognitive Behavioral Therapy Approach for Improving HIV Treatment Outcomes Among Violence-affected and Virally Unsuppressed Women in South Africa

This study will evaluate the impact of the Common Elements Treatment Approach (CETA), an evidence-based intervention comprised of cognitive-behavioral therapy elements, at improving HIV treatment outcomes among women with HIV who have experienced intimate partner violence (IPV) and have an unsuppressed viral load on HIV treatment. To evaluate CETA, the investigators will conduct a randomized controlled trial of HIV-infected women, with or without their partners, who have experienced IPV and have an unsuppressed viral load to test the effect of CETA in increasing viral suppression and reducing violence. The investigators will also identify mediators and moderators of CETA's effect on retention and viral suppression and assess the cost and cost-effectiveness of CETA vs. active control at increasing the proportion who are retained and virally suppressed by 12 months.

Read the detailed description

There are just under one million people with HIV in South Africa who have initiated antiretroviral therapy (ART) but remain unsuppressed. South Africa has been making progress towards UNAIDS 90-90-90 targets but currently only 47% of those infected are suppressed. In South Africa, one major barrier to consistent treatment is intimate partner violence (IPV); nearly 50% of women have experienced IPV. The Common Elements Treatment Approach (CETA) is an evidence-based intervention intended to provide coping skills to women who have experienced IPV, and is comprised of cognitive-behavioral therapy elements. It is a transdiagnostic tool that can flexibly address a range of mental health problems (e.g. depression, anxiety) and represents the current best practice in global mental health as a more cost-effective, scalable and sustainable model. CETA is one of the most promising interventions to impact HIV outcomes through addressing the indirect effects of IPV on adherence and continuity of care.

The investigators will conduct a randomized controlled trial of HIV-infected women, with or without their partners, who have experienced IPV and have an unsuppressed viral load to test the effect of CETA, in increasing retention and viral suppression, and reducing violence. The study aim is:

  • Among HIV-infected women on ART who have experienced IPV and have an unsuppressed viral load, assess the effectiveness of CETA vs. active control at increasing the proportion retained and virally suppressed by 12 months and at decreasing the severity and incidence of IPV and other mental and behavioral health problems using a randomized trial;

Study staff will obtain full informed consent from those who meet inclusion criteria. For those that agree to participate, study staff will then randomize patients to CETA or control using sealed randomization envelopes. All subjects will be followed for 12 months to ensure data for primary and secondary outcomes is complete. Follow-up HIV data will be passive using routinely collected medical records from the clinics. HIV outcomes will be assessed at 3 and 12-months post-baseline. Questionnaires on violence, substance use, and mental health will be administered at baseline, and at 3 months (following CETA end) and 12 months post-baseline. These include: Severity of Violence Against Women Scale, Center for Epidemiological Studies-Depression Scale, Harvard Trauma Questionnaire, and Alcohol, Smoking, and Substance Involvement Screening Test. The primary outcome will be retention and viral suppression (<50 copies/mL) by 12 months after randomization. Secondary outcomes will include: 1) Viral suppression at 3 months; 2) Attrition at 12 months; and 3) IPV, mental/behavioral health, alcohol and other substance use at 3 and 12 months.

The primary aim is to analyze the impact of CETA in the full study population; however, our sample size was calculated to ensure our ability to detect differences separately among women who include a partner in the CETA intervention and those who do not not (noting that partners are not enrolled in the study, they are only enrolled in CETA and as such are not study subjects). A sample of 400 women will be included which will give us 80% power to detect an absolute 21% difference between arms. The primary analysis will be a comparison of intervention and control by risk differences with 95% confidence intervals. The investigators will analyze direct effects of CETA on continuous outcomes (e.g., mental health) with linear mixed models. The impact of potential moderators on retention and mental health outcomes using interaction terms will be assessed.

Conditions
HIV/AIDS, Violence
Being tested
CETA, Short Message Service (SMS) text reminders
Keywords
HIV, Retention, Viral suppression, Violence, Cognitive behavioral therapy (CBT), Common Elements Treatment Approach (CETA)
Medical subject headings
Acquired Immunodeficiency Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CETABehavioural

    CETA is a modular, multi-problem, flexible psychotherapy approach that trains a lay provider in nine evidence-based CBT elements so providers can treat a variety of common problems, including violence, substance use, depression, anxiety, risky behaviors (sexual, non-adherence), and other trauma-related symptoms.

  • Short Message Service (SMS) text remindersOther

    Short Message Service (SMS) text reminders for upcoming appointments will be sent monthly.

Study groups in NCT04242992
Study groupRoleWhat they receive
CETA (Common Elements Treatment Approach)ExperimentalParticipants randomized to CETA arm will meet weekly with a lay provider or community health worker member of the study staff for about an hour once each week, approximately 6-12 times depending on presentation and symptom level. This treatment arm will include Short Message Service (SMS) text reminders of their HIV care appointments, similar to the active control group. As of October 12, 2022 participants can elect to have CETA delivered by telephone.
Receives: Behavioral: CETA; Other: Short Message Service (SMS) text reminders
Active controlActive comparatorParticipants randomized to the active control arm will receive usual care for intimate partner violence. Short Message Service (SMS) text messages will be sent monthly to our control group participants to remind them of HIV care appointments.
Receives: Other: Short Message Service (SMS) text reminders

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 12 Month Viral Suppression

    The proportion of participants who are virally suppressed (<50 copies/mL) by 12 months post randomization

    Measured: 12 months post randomization

Secondary outcomes (10)
  1. 3 Month Viral Suppression

    The proportion of participants who are virally suppressed (<50 copies/mL) by 3 months post randomization of those with a viral load at 3 months of follow-up

    Measured: 3 months post randomization

  2. 12 Month Attrition Rate

    Attrition rate (the opposite of retention) will be defined as the proportion of participants being more than 90 days late for a study visit 12 months post randomization.

    Measured: 12 months post randomization

  3. Violence Against Women at 3 Months

    Violence will be measured using the Severity of Violence Against Women Scale (SVAWS) physical/sexual violence subscale, a 27 item measure with a possible range of 27-108 and higher scores associated with greater severity of experienced violence.

    Measured: 3 months

  4. Violence Against Women at 12 Months

    Violence will be measured using the Severity of Violence Against Women Scale (SVAWS) physical/sexual violence subscale, a 27 item measure with a possible range of 27-108 and higher scores associated with greater severity of experienced violence.

    Measured: 12 months

  5. Substance Use at 3 Months

    Substance use will be measured with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), which includes 7 items on frequency of use, abuse, and dependence symptoms for the following substance types: tobacco, alcohol, inhalants, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opioids , or other substance. Higher scores are associated with greater substance involvement. ASSIST is a binary outcome of yes/no to any past-three month substance use, it is not a continuous measure. Scores can range from 0 to 1.

    Measured: 3 months

  6. Substance Use at 12 Months

    Substance use will be measured with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), which includes 7 items on frequency of use, abuse, and dependence symptoms for the following substance types: tobacco, alcohol, inhalants, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opioids , or other substance. Higher scores are associated with greater substance involvement. ASSIST is a binary outcome of yes/no to any past-three month substance use, it is not a continuous measure. Scores can range from 0 to 1.

    Measured: 12 months

  7. Post-traumatic Stress Disorder (PTSD) Symptoms at 3 Months

    PTSD symptoms will be assessed using 16 items scored on a four-point scale (1 = none, 2 = some of the time, 3 = a lot of the time, 4 = most of the time) from the Harvard Trauma Questionnaire (HTQ). HTQ scores can range from 1-4. Higher scores are associated with greater PTSD symptom severity.

    Measured: 3 months

  8. Post-traumatic Stress Disorder (PTSD) Symptoms at 12 Months

    PTSD symptoms will be assessed using 16 items scored on a four-point scale (1 = none, 2 = some of the time, 3 = a lot of the time, 4 = most of the time) from the Harvard Trauma Questionnaire (HTQ). HTQ scores can range from 1-4. Higher scores are associated with greater PTSD symptom severity.

    Measured: 12 months

  9. Depression Based on the Epidemiological Studies-Depression Scale (CES-D) Scale Score at 3 Months

    CES-D is a 20-item scale of depression with a possible range of 0-60 (total scale score). Higher scores are associated with greater depression symptom severity.

    Measured: 3 months

  10. Depression Based on the Epidemiological Studies-Depression Scale (CES-D) Scale Score at 12 Months

    CES-D is a 20-item scale of depression with a possible range of 0-60 (total scale score). Higher scores are associated with greater depression symptom severity.

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jan 2020
  2. Study start12 Nov 2021
  3. Primary completion23 May 2025
  4. Study completion23 May 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
Women will be randomized 1:1 to either CETA or an active attention control arm.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
399 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04242992
Sponsor's protocol ID
H-39746
Other IDs
1R01MH121998
Acronym
CETA
Status last verified
Feb 2026
First submitted
23 Jan 2020
Last updated
19 Feb 2026
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Once the research team has had sufficient time to analyze the data and submit the results for the primary study aims, the data will be made available on request in de-identified format for selected outcome measures. Only those original data collected by the study team can be shared, clinical records owned by the government cannot.

Publications

  • Zheng A, Kane JC, Mngadi-Ncube S, Fox MP, Manganye P, Long L, Metz K, Sardana S, Alto M, Greener R, Thea DM, Murray LK, Pascoe S. Effectiveness of the Common Elements Treatment Approach for mental and behavioural health outcomes among women struggling to remain adherent to HIV treatment and who have experienced intimate partner violence in South Africa: secondary outcomes from a randomised controlled trial. BMJ Ment Health. 2026 Jan 27;29(1):e302246. doi: 10.1136/bmjment-2025-302246.

    PubMed 41592903
  • Zheng A, Kane JC, Mngadi-Ncube S, Fox MP, Manganye P, Long L, Metz K, Sardana S, Alto M, Greener R, Thea DM, Murray LK, Pascoe S. Effectiveness of the Common Elements Treatment Approach (CETA) for mental and behavioral health outcomes among women struggling to remain adherent to HIV treatment and who have experienced intimate partner violence in South Africa: A randomised controlled trial. medRxiv [Preprint]. 2025 Oct 15:2025.10.14.25337970. doi: 10.1101/2025.10.14.25337970.

    PubMed 41282709
  • Pascoe S, Fox M, Kane J, Mngadi S, Manganye P, Long LC, Metz K, Allen T, Sardana S, Greener R, Zheng A, Thea DM, Murray LK. Study protocol: A randomised trial of the effectiveness of the Common Elements Treatment Approach (CETA) for improving HIV treatment outcomes among women experiencing intimate partner violence in South Africa. BMJ Open. 2022 Dec 22;12(12):e065848. doi: 10.1136/bmjopen-2022-065848.

    PubMed 36549749

Questions about this trial

What is this clinical trial studying?

A study testing CETA and Short Message Service (SMS) text reminders in people with HIV/AIDS and Violence, run by Boston University at 1 site in South Africa.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in South Africa. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 19 Feb 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

12 Month Viral Suppression (time frame: 12 months post randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04242992, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Feb 2026.

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