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

针对马拉维感染艾滋病毒的围产期妇女采用友谊长凳心理健康干预措施

基本信息

批准号：
10543244
负责人：
Angela Bengtson
金额：
$ 7.83万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-15 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10543244
关键词：
Address Adult Adverse effects Affect Africa South of the Sahara African Applications Grants Appointment Attention Breast Feeding Caring Clinic Clinical Counseling Country Depressed mood Depression screen Development Disease Effectiveness Family Focus Groups Friendships General Population Goals HIV HIV therapy Health Health Personnel Individual Infant Infrastructure Intervention Interview Lead Link Malawi Maternal Health Maternal and Child Health Measures Mental Depression Mental Health Methods Modeling Mother-to-child HIV transmission Outcome Output Perinatal Persons Pilot Projects Population Postpartum Period Postpartum Women Pregnancy Pregnant Women Prevalence Protocols documentation Randomized Controlled Trials Research Resource-limited setting Resources Role Supervision Testing Text Messaging Training Woman Work acceptability and feasibility aged antenatal antepartum depression antiretroviral therapy arm base care outcomes critical period effectiveness trial evidence base experience improved innovation parent grant perinatal HIV perinatal mental health perinatal period perinatal women peripartum depression postnatal preference pregnant problem solving therapy programs protocol development reproductive scale up standard care success therapy design therapy development treatment adherence treatment group

项目摘要

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.

摘要 {摘要与家长补助金申请中提供的内容保持一致} 在许多撒哈拉以南非洲国家，将终身抗逆转录病毒治疗（ART）扩大到所有人选项 B+ 下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，分娩后失去艾滋病毒护理已成为一个问题对选项 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失去艾滋病毒护理是围产期抑郁症（PND）。 PND 影响高达 43% 的 HIV 感染女性怀孕期间和 31% 的 HIV 感染妇女产后。在非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毒恶化有关临床结果。因此，将 PND 治疗与艾滋病毒护理保留的有针对性的支持相结合的干预措施对于选项 B+ 的成功至关重要。友谊长凳是一种基于证据的抑郁症咨询干预措施，由经过培训的、监督非专业卫生工作者。友谊长凳被证明可以减少普通人群的抑郁症在资源匮乏的环境中，但尚未适应解决 PND，或增强以支持参与艾滋病毒护理。友谊长凳以解决问题疗法为基础，为友谊提供了一个理想的框架将保留支持纳入经过验证的抑郁症治疗模型。我们的长期目标是适应、测试、扩大资源适当的干预措施，以减少 PND 并提高艾滋病毒护理的参与度。这该提案的目标是通过以下方式为有效性试验奠定基础：（1）调整友谊进行基准干预，以解决 PND 问题并支持围产期 HIV 感染妇女和妇女参与护理工作 (2) 评估调整干预措施的可行性、可接受性和保真度。拟议的项目将方案 B+ 于 2011 年首次在马拉维利隆圭进行试点。对 PND 和其在参与护理方面的作用将从患有 PND 的 HIV 感染女性、医疗保健提供者、诊所收集董事和卫生部官员使用定性访谈和焦点小组。这项形成性研究将用于制定适应艾滋病毒感染妇女在艾滋病毒感染期间的独特需求的干预方案围产期（改编友谊长凳）并进一步加强以支持参与艾滋病毒护理（增强友谊长凳）。将比较调整后的和增强的友谊长凳干预措施在三组试点研究中加强标准护理。可行性、可接受性和保真度将在 6 进行评估产后几个月，以及干预措施在多个心理健康和参与艾滋病毒护理措施。拟议的目标为 R01 应用程序测试适应的方法铺平了道路并在整群随机对照试验中加强友谊长凳干预，并代表朝着改善艾滋病毒感染妇女的 PND 迈出重要一步，并最终改善艾滋病毒结果选项 B+ 计划中的女性。