Adaptation of the Friendship Bench mental health intervention for HIV-infected perinatal women in Malawi

摘要{摘要与父母补助金申请中提供的内容相同} 在许多撒哈拉以南非洲国家，扩大终身抗逆转录病毒治疗， 选择B+的孕妇和哺乳期妇女有可能从根本上改善孕产妇健康， 减少艾滋病毒母婴传播。然而，分娩后艾滋病毒护理的损失已成为一个严重的问题， 对方案B+的预期影响构成重大威胁。有证据表明，一个重要的贡献者， 产后艾滋病护理的损失是围产期抑郁症（PND）。PND影响高达43%的艾滋病毒感染妇女 怀孕期间和产后感染艾滋病毒的妇女中有31%。在未怀孕的艾滋病毒感染人群中， 抑郁症与抗逆转录病毒治疗依从性差、护理参与度降低以及最终导致艾滋病恶化有关 临床结果。因此，将PND治疗与有针对性的艾滋病毒护理保留支持相结合的干预措施， 是选项B+成功的关键。 友谊长凳是一个以证据为基础的抑郁症咨询干预提供训练有素， 监督非专业卫生工作者。友谊长凳被证明可以减少一般人群的抑郁症 在低资源环境下，但尚未调整以解决PND，或加强以支持参与 艾滋病毒护理。友谊长凳是基于解决问题的治疗，它提供了一个理想的框架， 将保留支持整合到经过验证的抑郁症治疗模型中。我们的长期目标是适应，测试， 并扩大资源适当的干预措施，以减少PND和改善对艾滋病毒护理的参与。的 本提案的目的是通过以下方式为有效性试验奠定基础：（1）调整友谊 在感染艾滋病毒的围产期妇女中开展干预措施，以解决产后营养不良问题，并支持她们参与护理， (2)评估适应性干预的可行性、可接受性和保真度。拟议项目将 方案B+于2011年在马拉维利隆圭首次试行。关于PND的深入观点， 它在参与护理方面的作用将从患有PND的艾滋病毒感染妇女、保健提供者、诊所 主任和卫生部官员使用定性访谈和焦点小组。这种形成性研究 将用于制定一项干预方案，以适应艾滋病毒感染妇女在 围产期（经过调整的友谊长凳），并进一步加强，以支持参与艾滋病毒护理 （增强型友谊长凳）。将对调整后的和增强的友谊实验室干预进行比较 在一项三组试点研究中加强标准治疗。可行性，可接受性和保真度将在6 产后沿着，随着干预措施在几个心理健康和 参与艾滋病毒护理措施。提出的目标为R 01应用程序测试适应的 和增强友谊实验室干预在一个集群随机对照试验，并代表一个 这是朝着改善艾滋病毒感染妇女的产后诊断和最终艾滋病毒结果迈出的重要一步， 选择B+方案的妇女。

ABSTRACT {Abstract remains the same as provided in the parent grant application} In many sub-Saharan African countries, the scale-up of lifelong antiretroviral treatment (ART) to all pregnant and breastfeeding women under Option B+ has the potential to radically improve maternal health and reduce mother-to-child HIV transmission. However, loss to HIV care after delivery has emerged as an important threat to the hoped-for impact of Option B+. Evidence suggests that one important contributor to postpartum loss to HIV care is perinatal depression (PND). PND affects up to 43% of HIV-infected women during pregnancy and 31% of HIV-infected women postpartum. In non-pregnant HIV-infected populations, depression has been linked to poor ART adherence, reduced engagement in care, and ultimately worse HIV clinical outcomes. Thus, interventions that integrate PND treatment with targeted support for HIV care retention are critical to the success of Option B+. The Friendship Bench is an evidence-based depression counseling intervention delivered by trained, supervised lay health workers. The Friendship Bench is proven to reduce depression in the general population in low-resource settings, but has not been adapted to address PND, or enhanced to support engagement in HIV care. The Friendship Bench is based on problem-solving therapy, which offers an ideal framework for integrating retention support into a proven depression treatment model. Our long-term goal is to adapt, test, and scale up resource-appropriate interventions to reduce PND and improve engagement in HIV care. The objective of this proposal is to lay the groundwork for an effectiveness trial by (1) adapting the Friendship Bench intervention to address PND and support engagement in care among perinatal HIV-infected women and (2) assessing the feasibility, acceptability, and fidelity of the adapted intervention. The proposed project will take place in Lilongwe, Malawi, where Option B+ was first piloted in 2011. In-depth perspectives on PND and its role in engagement in care will be gathered from HIV-infected women with PND, healthcare providers, clinic directors, and Ministry of Health officials using qualitative interviews and focus groups. This formative research will be used to develop an intervention protocol adapted to the unique needs of HIV-infected women during the perinatal period (Adapted Friendship Bench) and further enhanced to support engagement in HIV care (Enhanced Friendship Bench). The Adapted and Enhanced Friendship Bench interventions will be compared to enhanced standard care in a 3-arm pilot study. Feasibility, acceptability, and fidelity will be assessed at 6 months postpartum, along with the interventions’ preliminary effectiveness across several mental health and engagement in HIV care measures. The proposed aims pave the way for a R01 application to test the adapted and enhanced Friendship Bench interventions in a cluster randomized controlled trial and represent an important step forward towards improving PND among HIV-infected women, and ultimately HIV outcomes for women in the Option B+ program.