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

• 批准号: 9762203
• 负责人: Angela Bengtson
• 金额: $ 22.76万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762203
• 关键词: Address; Adult; Adverse effects; Affect; Africa South of the Sahara; African; 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; Pilot Projects; Population; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevalence; Protocols documentation; Randomized Controlled Trials; Research; Resources; Role; Supervision; Testing; Text Messaging; Training; Woman; Work; aged; antenatal; antepartum depression; antiretroviral therapy; arm; base; care outcomes; critical period; effectiveness trial; evidence base; experience; improved; innovation; 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

ABSTRACT 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 在许多撒哈拉以南非洲国家，向所有人扩大终身抗逆转录病毒治疗(ART) 备选方案B+下的孕妇和哺乳期妇女有可能从根本上改善产妇健康和 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种 对备选方案B+预期影响的重大威胁。证据表明，一个重要的贡献者 产后失去对艾滋病毒的护理是围产期抑郁(PND)。PND影响高达43%的艾滋病毒感染妇女 在怀孕期间和产后感染艾滋病毒的妇女中，有31%。在非怀孕的艾滋病毒感染人群中， 抑郁症与不良的抗逆转录病毒治疗依从性、减少护理参与度以及最终恶化的艾滋病毒有关。 临床结果。因此，将PND治疗与艾滋病毒护理保留的定向支持相结合的干预措施 对备选方案B+的成功至关重要。 友谊长椅是一种基于证据的抑郁症咨询干预，由Traded， 受监督的业馀卫生工作者。友谊长椅被证明可以减少普通人群中的抑郁 在低资源环境中，但尚未调整为解决PND问题，或增强为支持 爱滋病护理。友谊长椅是基于解决问题的疗法，这为 将保留支持整合到经过验证的抑郁症治疗模式中。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。这个 这项建议的目标是通过以下方式为有效性试验奠定基础：(1)适应友谊 应对PND和支持围产期感染艾滋病毒妇女参与护理的长凳干预措施 (2)评估适应性干预的可行性、可接受性和保真度。拟议的项目将 在马拉维的利隆圭举行，方案B+于2011年在那里首次试行。PND和PND的深入视角 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、医疗保健提供者、诊所 主任和卫生部官员使用定性访谈和焦点小组。这项形成性研究 将被用来制定一项干预方案，以适应艾滋病毒感染妇女在 围产期(调整后的友谊长椅)，并进一步加强，以支持参与艾滋病毒护理 (强化友谊长凳)。将比较调整后的和增强的友谊板凳干预措施 在一项三臂试验性研究中加强标准护理。可行性、可接受性和保真度将在6 产后几个月，以及这些干预措施在几个心理健康和 参与艾滋病毒护理措施。建议的目标是为R01应用程序测试改编的 和增强型友谊长椅干预在一项整群随机对照试验中进行，代表了 在改善艾滋病毒感染妇女的PND方面向前迈出了重要的一步，并最终取得了艾滋病毒的成果 参加Option B+计划的女性。