An Intervention to Improve Mental Health and HIV Care Engagement Among Perinatal Women in Malawi: A Pilot Randomized Controlled Trial

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  • Bengtson, A.M.
    • Other Affiliation: Brown University
  • Filipowicz, T.R.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Mphonda, S.
    • Affiliation: School of Medicine, UNC Project-Malawi
  • Udedi, M.
    • Other Affiliation: Malawi Ministry of Health
  • Kulisewa, K.
    • Other Affiliation: Kamuzu University of Health Sciences
  • Meltzer-Brody, S.
    • Affiliation: School of Medicine, Department of Psychiatry
  • Gaynes, B.N.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Go, V.F.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Chibanda, D.
    • Other Affiliation: University of Zimbabwe
  • Verhey, R
    • Other Affiliation: Friendship Bench Zimbabwe
  • Hosseinipour, M.C
    • Affiliation: School of Medicine, UNC Project-Malawi
  • Pence, B.W
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Perinatal depression (PND) is common and an important barrier to engagement in HIV care for women living with HIV (WLHIV). Accordingly, we adapted and enhanced The Friendship Bench, an evidence-based counseling intervention, for perinatal WLHIV. In a pilot randomized trial (NCT04143009), we evaluated the feasibility, acceptability, fidelity, and preliminary efficacy of the Enhanced Friendship Bench (EFB) intervention to improve PND and engagement in HIV care outcomes. Eighty pregnant WLHIV who screened positive for PND symptoms on the Self-Report Questionnaire (≥ 8) were enrolled, randomized 1:1 to EFB or usual care, and followed through 6 months postpartum. Overall, 100% of intervention participants were satisfied with the intervention and 93% found it beneficial to their overall health. Of 82 counseling sessions assessed for fidelity, 83% met or exceeded the fidelity threshold. At 6 months postpartum, intervention participants had improved depression remission (59% versus 36%, RD 23%, 95% CI 2%, 45%), retention in HIV care (82% versus 69%, RD 13%, -6%, 32%), and viral suppression (96% versus 90%, RD 7%, -7%, 20%) compared to usual care. Adverse events did not differ by arm. These results suggest that EFB intervention should be evaluated in a fully powered randomized trial to evaluate its efficacy to improve PND and engagement in HIV care outcomes for WLHIV.
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  • Article
Journal title
  • AIDS and Behavior
Language
  • English
Funder
  • National Institutes of Health, NIH: D43 TW010060, P30 AI050410, R00MH112413, R34MH116806
  • Center for AIDS Research, University of Washington, CFAR
  • Center for AIDS Research, University of North Carolina at Chapel Hill, UNC CFAR
ISSN
  • 1090-7165
Publisher
  • Springer

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