(PS9-50) Prolonged Exposure for PTSD in South Africa: Preliminary Findings

Post-traumatic stress disorder (PTSD) is a global mental health concern, especially in low and middle-income countries (LMICs) characterized by ongoing adversity and limited access to evidence-based mental healthcare. Prolonged exposure therapy (PE) is a first-line treatment for PTSD, yet implementation studies on PE in LMICs are limited. Moreover, the World Health Organization’s (WHO) guidelines on the management of trauma- and stressor-related disorders highlight crucial aspects related to the management of stressor-related conditions such as PTSD in LMICs. In particular, the WHO has stated that it is difficult to manage PTSD cases in many LMICs where there is ongoing adversity including marked levels of poverty, gender-based violence, and increased levels of trauma exposure. Using a mixed methods pilot implementation design, we investigated whether (a) task-sharing PE at a community trauma centre would be perceived as feasible among mental health providers, (b) whether clients would experience and perceive PE as an acceptable, and (c) whether a task-shared PE intervention can improve symptoms of PTSD and Depression among South African nationals and refugees seeking treatment at a community trauma centre. We recruited three samples, namely, clients seeking trauma counselling for symptoms of PTSD (n = 5), mental health providers to implement PE (n = 4), and clients who received PE for PTSD (n=5). Treatment outcomes were measured using the PTSD Checklist for DSM5 (PCL5) and the Patient Health Questionnaire-9 (PHQ9) and qualitative data was collected using semi-structured interviews. The mean number of sessions completed across all five cases were 12. For PTSD, pre-intervention mean scores (m = 53) to post had a modest improvement (m = 44). For Depression, greater symptom improvement from pre (m = 20) to post (m= 15) was observed. Interviews with providers suggested that PE was a relevant treatment for PTSD, yet organisational readiness and staff workload were barriers. Clients who received PE stated that exposure was initially difficult but that they also experienced reduced fear related to the trauma memories(s), and reported to improved interpersonal functioning. Importantly, refugee participants presented with more complex comorbidity such as severe hopelessness and co-dependency, and experienced ongoing adversity during treatment such as xenophobic attacks. Our pilot study provides preliminary insights into treating PTSD in settings of ongoing adversity, diagnostic complexity of refugee trauma survivors, and the importance of organisational readiness when implementing evidence-based interventions.