Integration of stepped care for Perinatal Mood and Anxiety Disorders among Women Living with HIV in Kenya

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT Perinatal mood and anxiety disorders (PMAD), defined as depression and anxiety during pregnancy or up to 1 year postpartum, affect 10-20% of pregnant and postpartum women, with elevated burden in low- and middle- income countries (LMICs, >20%) and among women living with HIV (WLWH, >25%). Meeting the need for PMAD treatment among WLWH in LMICs requires integration of evidence-based interventions (EBIs) into routine antenatal and prevention of mother to child HIV transmission (PMTCT) services. In Kenya, such efforts have been prioritized in national mental health policy strategy, but their delivery has been limited by lack of provider training and poor linkage across provider cadres (e.g., primary care and mental health providers). There is a need for development and testing of tailored interventions that strengthen workforce capacity and facilitate linkage across provider cadres, as well as implementation strategies to facilitate high- quality intervention delivery. We have identified three EBIs to promote perinatal mental health: (1) universal mental health screening, (2) the Problem Management Plus (PM+) counseling intervention for women experiencing PMAD, and (3) telepsychiatry for women with severe symptoms or no response to PM+. We propose to combine these interventions in a stepped care model, named the Integrated Perinatal Mental Health program (IPMH), and develop implementation strategies to support its integration into routine PMTCT care in Kenya. We will then evaluate IPMH’s effectiveness and implementation outcomes in a Hybrid Type II cluster-randomized trial in 20 healthcare facilities in Western Kenya, the region with the highest HIV prevalence in the country. In Aim 1, we will use participatory design to optimize and adapt IPMH and develop implementation strategies. In Aim 2, we will determine the effect of IPMH and its implementation strategies on mental health, HIV care, and pregnancy outcomes among WLWH from pregnancy to 6 months postpartum. In Aim 3, we will determine effect of IPMH and its implementation strategies on service delivery and implementation outcomes, and identify multilevel drivers of successful implementation. We hypothesize that provision of the IPMH stepped care intervention in routine PMTCT services, along with tailored implementation strategies, will (1) lead to lower depression and anxiety symptoms, lower adverse pregnancy outcomes, and better quality of life; and (2) increase penetration and equity of care provision to WLWH experiencing PMAD. IPMH has potential to address a critical gap in treatment of PMAD among WLWH in resource-limited settings. Completion of these aims will generate rigorous data on both IPMH’s effectiveness and the implementation strategies for high quality and sustainable delivery of a ready-to-scale intervention.