The efficacy and mechanism of an integrated mindfulness-based programme on posttraumatic stress disorder among people with HIV: a randomized controlled trial with 3-month follow up

<b>Background:</b> Posttraumatic stress disorder (PTSD) is highly prevalent among people with HIV (PWH) and is associated with poor psychological functioning and reduced adherence to antiretroviral therapy (ART), threatening treatment outcomes. Although the Community Resiliency Model (CRM) and mindfulness-based stress reduction (MBSR) have separately demonstrated efficacy for PTSD, no intervention integrating these approaches has been specifically developed for PWH.<b>Objective:</b> This study aimed to evaluate the efficacy and mechanisms of an Integrated Mindfulness-Based Programme (IMBP), combining CRM and MBSR, in reducing PTSD symptoms and enhancing ART adherence among PWH.<b>Methods:</b> Eighty-two PWH with PTSD were assigned to either the IMBP intervention group or the control group. PTSD symptoms and ART adherence were assessed at baseline, post-intervention, and 3-month follow-up. Mindfulness, rumination, and resilience were evaluated as potential mediators. Data were analyzed using generalized estimating equations (GEE) and mediation modelling.<b>Results:</b> Compared with the control group, participants receiving IMBP demonstrated significantly greater reductions in PTSD symptoms and improvements in ART adherence, both immediately post-intervention and at 3-month follow-up (all <i>p</i> < .01). Mediation analysis revealed that increased mindfulness, enhanced resilience, and decreased rumination partially mediated the effect of the intervention on PTSD symptoms.<b>Conclusion:</b> The IMBP intervention was effective in reducing PTSD symptoms as well as improving ART adherence in PWH. The mediating roles of mindfulness, resilience, and rumination suggest plausible mechanisms through which the intervention operates. These findings support the clinical utility of IMBP as a low-resource intervention for addressing the dual challenges of trauma and treatment adherence in vulnerable HIV-positive populations.