An Intervention to Improve Mental Health and HIV Care Engagement Among Perinatal Women in Malawi: A Pilot Randomized Controlled Trial

Abstract

Perinatal depression (PND) is common and an important barrier to engagement in HIV care for women living with HIV (WLHIV). Accordingly, we adapted and enhanced The Friendship Bench, an evidence-based counseling intervention, for perinatal WLHIV. In a pilot randomized trial (NCT04143009), we evaluated the feasibility, acceptability, fidelity, and preliminary efficacy of the Enhanced Friendship Bench (EFB) intervention to improve PND and engagement in HIV care outcomes. Eighty pregnant WLHIV who screened positive for PND symptoms on the Self-Report Questionnaire (≥ 8) were enrolled, randomized 1:1 to EFB or usual care, and followed through 6 months postpartum. Overall, 100% of intervention participants were satisfied with the intervention and 93% found it beneficial to their overall health. Of 82 counseling sessions assessed for fidelity, 83% met or exceeded the fidelity threshold. At 6 months postpartum, intervention participants had improved depression remission (59% versus 36%, RD 23%, 95% CI 2%, 45%), retention in HIV care (82% versus 69%, RD 13%, -6%, 32%), and viral suppression (96% versus 90%, RD 7%, -7%, 20%) compared to usual care. Adverse events did not differ by arm. These results suggest that EFB intervention should be evaluated in a fully powered randomized trial to evaluate its efficacy to improve PND and engagement in HIV care outcomes for WLHIV. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-023-04070-8.

Friendship Bench Intervention to Address Depression and Improve HIV Care Engagement Among Adolescents Living with HIV in Malawi: Study Protocol for a Pilot Randomized Controlled Trial

“…The checklist consists of 10 items corresponding to 10 core session components rating from "1 -Component not done" to "4 -Component exceeds expectations" for each component. Covering at least 80% of checklist items will be considered fidelity to the intervention protocol (Bengtson et al, 2023). Acceptability will be defined as the ability to deliver a culturally and resource-appropriate intervention.…”

Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme–Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi

“…In a pilot Randomized Controlled Trial (RCT) in Malawi, an adapted counseling intervention (the Friendship Bench) delivered to women living with HIV who screened positive for perinatal depression, improved maternal health outcomes. Women in the intervention arm showed higher depressive symptom reduction, better retention in HIV care, and there was a trend toward greater viral suppression, compared to the control group [ 20 ].…”

Phone-based psychosocial counseling for people living with HIV: Feasibility, acceptability and impact on uptake of psychosocial counseling services in Malawi

“…Some promising interventions that work with adolescents living with HIV and pregnant women aim to address these gaps in the delivery of mental health services. They achieve this by training lay cadres to provide in-person and virtual counseling, as well as by creating text messaging-based support group interventions (Chibanda et al, 2016 ; Skinner et al, 2018 ; Atujuna et al, 2021 ; Dambi et al, 2022 ; Bengtson et al, 2023 ). Critical work exploring the complexities and nuance of adapting such interventions to a larger scale is ongoing (Chibanda, 2017 ; Stockton et al, 2020 ; Moitra et al, 2023 ).…”