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

Journal: AIDS and behavior

Volume: 27

Issue: 11

Year of Publication: 2023

Affiliated Institutions:  Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA. angela_bengtson@brown.edu. Department of Epidemiology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA. UNC Project Malawi, Lilongwe, Malawi. Mental Health Unit, Malawi Ministry of Health, Lilongwe, Malawi. Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi. Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA. Department of Health Behavior, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA. Department of Psychiatry & Research Support Centre, University of Zimbabwe, Harare, Zimbabwe. Friendship Bench Zimbabwe, Harare, Zimbabwe.

Abstract summary 

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.

Authors & Co-authors:  Bengtson Angela M AM Filipowicz Teresa R TR Mphonda Steven S Udedi Michael M Kulisewa Kazione K Meltzer-Brody Samantha S Gaynes Bradley N BN Go Vivian F VF Chibanda Dixon D Verhey Ruth R Hosseinipour Mina C MC Pence Brian Wells BW

Study Outcome 

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Statistics
Citations :  WHO . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva, Switzerland: World Health Organization; 2013.
Authors :  12
Identifiers
Doi : 10.1007/s10461-023-04070-8
SSN : 1573-3254
Study Population
Female,Women
Mesh Terms
Pregnancy
Other Terms
Engagement in HIV care;HIV;Malawi;Option B+;Perinatal depression
Study Design
Randomized Control Trial
Study Approach
Country of Study
Publication Country
United States