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{摘要与父母赠款应用程序中提供的相同在许多撒哈拉以南非洲国家，对所有人的终身抗逆转录病毒治疗（ART）扩大孕妇和母乳喂养妇女的选择B+有可能从根本上改善孕产妇的健康和减少母亲到孩子的艾滋病毒传播。但是，分娩后因艾滋病毒护理的损失已成为对选项B+的希望影响的重要威胁。有证据表明，一个重要的贡献者产后对HIV护理的损失是围产期抑郁症（PND）。 PND最多影响43％的HIV感染妇女在怀孕期间，产后31％的艾滋病毒感染妇女。在未怀孕的HIV感染人群中，抑郁症与艺术依从性差，减少了护理的参与以及最终更糟的艾滋病毒有关临床结果。这是将PND治疗与针对性支持HIV护理保留的干预措施对于选项B+的成功至关重要。友谊长凳是由受过训练的良好抑郁咨询干预措施监督外行卫生工作者。事实证明，友谊长凳可以减少普通人群的抑郁症在低资源设置中艾滋病毒护理。友谊长凳是基于解决问题的疗法的，该疗法为将保留支持整合到一个经过验证的抑郁治疗模型中。我们的长期目标是适应，测试，并扩大适合资源的干预措施，以减少PND并改善艾滋病毒护理的参与度。这该提议的目的是通过（1）调整友谊来为有效性试验奠定基础替补干预措施以解决PND并支持围产期艾滋病毒感染的妇女和（2）评估适应性干预措施的可行性，可接受性和保真度。拟议的项目将在马拉维的莉隆威举行，该选项B+在2011年首次驾驶。它在参与护理方面的作用将从PND，医疗保健提供者，诊所的艾滋病毒感染的妇女那里收集董事和卫生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合艾滋病毒感染妇女在此期间的独特需求的干预方案围产期（改编的友谊长凳），并进一步增强以支持参与艾滋病毒护理（增强的友谊长凳）。将比较适应和增强的友谊板凳干预措施在三臂试点研究中增强了标准护理。可行性，可接受性和忠诚度将在6点进行评估产后几个月，以及干预措施在几种心理健康和参与艾滋病毒护理措施。拟议的旨在为R01应用程序铺平道路测试适应的并在集群随机对照试验中增强了友谊台干预措施，并代表朝着改善HIV感染妇女的PND的重要一步，并最终为HIV结果选项B+计划中的女性。