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Dao TT, Gaynes BN, Pence BW, Mphonda SM, Kulisewa K, Udedi M, Stockton MA, Kramer J, Faidas M, Mortensen H, Bhushan NL. Friendship Bench Intervention to Address Depression and Improve HIV Care Engagement Among Adolescents Living with HIV in Malawi: Study Protocol for a Pilot Randomized Controlled Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.11.24305686. [PMID: 38645199 PMCID: PMC11030483 DOI: 10.1101/2024.04.11.24305686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present a pilot trial designed to investigate feasibility, fidelity, and acceptability of an a dapted and an e nhanced F riendship B ench intervention (henceforth: AFB and EFB) in reducing depression and improving engagement in HIV care among ALWH in Malawi. Methods Design: Participants will be randomized to one of three conditions: the Friendship Bench intervention adapted for ALWH (AFB, n=35), the Friendship Bench intervention enhanced with peer support (EFB, n=35), or standard of care (SOC, n=35). Recruitment is planned for early 2024 in four clinics in Malawi.Participants: Eligibility criteria (1) aged 13-19; (2) diagnosed with HIV (vertically or horizontally); (3) scored ≥ 13 on the self-reported Beck's Depression Inventory (BDI-II); (4) living in the clinic's catchment area with intention to remain for at least 1 year; and (5) willing to provide informed consent.Interventions: AFB includes 6 counseling sessions facilitated by young, trained non-professional counselors. EFB consists of AFB plus integration of peer support group sessions to facilitate engagement in HIV care. SOC for mental health in public facilities in Malawi includes options for basic supportive counseling, medication, referral to mental health clinics or psychiatric units at tertiary care hospitals for more severe cases.Outcomes: The primary outcomes are feasibility, acceptability, and fidelity of the AFB and EFB assessed at 6 months and 12 months and compared across 3 arms. The secondary outcome is to assess preliminary effectiveness of the interventions in reducing depressive symptoms and improving HIV viral suppression at 6 months and 12 months. Discussion This pilot study will provide insights into youth-friendly adaptations of the Friendship Bench model for ALWH in Malawi and the value of adding group peer support for HIV care engagement. The information gathered in this study will lead to a R01 application to test our adapted intervention in a large-scale cluster randomized controlled trial to improve depression and engagement in HIV care among ALWH. Trial registration ClinicalTrials.gov Identifier NCT06173544.
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Dolan E, Cosgrave C, Killackey E, Allott K. Impact of rural settings on the interpersonal and personal processes associated with young people supporting a peer who experienced a traumatic event. Aust J Rural Health 2023; 31:1103-1114. [PMID: 37698078 DOI: 10.1111/ajr.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/18/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION There is limited research into informal support processes amongst young people supporting a peer through a traumatic event and how this process occurs specifically within a rural setting. OBJECTIVE The aim of this research was to understand how the contextual environment impacts on the personal and interpersonal processes of rural-based young people supporting a peer who experienced a traumatic event. DESIGN Qualitative interviews were conducted with 22 young people (aged 14-19), who resided in Gippsland, Victoria, Australia. A substantive theory was developed using Charmaz's (1) Constructivist grounded theory methodology. FINDINGS Young people who shared responsibility for supporting their peer went back to life as normal and felt connected to their community, whereas young people who maintained sole responsibility, experienced mental health problems, disconnected from their community and felt like an outsider. The contextual environmental factors (i.e., service accessibility, limited transport, and internet blackspots) impacted both negatively and positively on young people's ability to provide support as well as influenced whether they felt safe share responsibility. DISCUSSION This theory implies that providing pathways to reconnecting with place and community, are essential in guiding young people back to their foundations of support. CONCLUSION Integrating these insights can create new service models in rural areas, whilst also creating opportunities to form healthy foundations of support.
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Affiliation(s)
- Erin Dolan
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Cosgrave
- Adjunct - University of New England School of Rural Medicine, Armidale, Australia
| | - Eóin Killackey
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Simbeza S, Mutale J, Mulabe M, Jere L, Bukankala C, Sikombe K, Sikazwe I, Bolton-Moore C, Mody A, Geng EH, Sharma A, Beres LK, Pry JM. Cross-sectional study to assess depression among healthcare workers in Lusaka, Zambia during the COVID-19 pandemic. BMJ Open 2023; 13:e069257. [PMID: 37019489 PMCID: PMC10083529 DOI: 10.1136/bmjopen-2022-069257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES We sought to assess depression among healthcare workers (HCWs) in the context of COVID-19 in Lusaka Province, Zambia. DESIGN This cross-sectional study is nested within a larger study, the Person-Centred Public Health for HIV Treatment in Zambia (PCPH), a cluster-randomised trial to assess HIV care and outcomes. SETTING The research was conducted in 24 government-run health facilities from 11 August to 15 October 2020 during the first wave of the COVID-19 pandemic in Lusaka, Zambia. PARTICIPANTS We used convenience sampling to recruit HCW participants who were previously enrolled in the PCPH study, had more than 6 months' experience working at the facility and were voluntarily willing to participate. PRIMARY OUTCOME MEASURES We implemented the well-validated 9-question Patient Health Questionnaire (PHQ-9) to assess HCW depression. We used mixed-effects, adjusted Poisson regression to estimate the marginal probability of HCWs experiencing depression that may warrant intervention (PHQ-9 score ≥5) by healthcare facility. RESULTS We collected PHQ-9 survey responses from 713 professional and lay HCWs. Overall, 334 (46.8%, 95% CI 43.1%, 50.6%) HCWs recorded a PHQ-9 score ≥5, indicating the need for further assessment and potential intervention for depression. We identified significant heterogeneity across facilities and observed a greater proportion of HCWs with symptoms of depression in facilities providing COVID-19 testing and treatment services. CONCLUSIONS Depression may be a concern for a large proportion of HCWs in Zambia. Further work to understand the magnitude and aetiologies of depression among HCWs in the public sector is needed to design effective prevention and treatment interventions to meet the needs for mental health support and to minimise poor health outcomes.
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Affiliation(s)
- Sandra Simbeza
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jacob Mutale
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Musunge Mulabe
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Lazarus Jere
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chama Bukankala
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kombatende Sikombe
- Implementation Science Unit, Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Izukanji Sikazwe
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Aaloke Mody
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Anjali Sharma
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jake M Pry
- Implementation Science Unit, Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Public Health Sciences, University of California Davis School of Medicine, Sacramento, California, USA
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Brooks MJ, Phetogo BK, Schwennesen H, Phoi O, Tshume O, Matshaba M, Lowenthal E. Building a Community Based Mental Health Program for Adolescents in Botswana: Stakeholder Feedback. Community Ment Health J 2022; 58:1068-1075. [PMID: 34826035 PMCID: PMC9172915 DOI: 10.1007/s10597-021-00915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND When planning interventions for adolescents, adult interventions should not be used 'as is' in youth settings. Stakeholder engagement can help understand the overall adolescent mental health ecosystem and adapt existing evidence-based interventions for the youth. OBJECTIVE To understand the overall mental health needs of adolescents in Botswana and the necessary adaptations required for an adolescent lay counselor based intervention in the country. METHODS We used the theory of change model and the nominal group technique in five stakeholder meetings. Meetings were held to discuss the mental health needs of youth in Botswana and identify priorities for a lay counsellor based intervention modelled after the Friendship Bench intervention, an existing mental health intervention for adults. RESULTS The root causes of mental health problems among Botswana's youth identified by stakeholders included limited mental health knowledge among the youth and the community, family problems, poor communication, low self-esteem, the rapid growth of technology, and biological/genetic predisposition. Structurally barriers included: mental illness-related stigma, lack of psychosocial support, incomplete follow up for health services, cultural beliefs about mental illness, and fragmented mental health services. The stakeholders envisage a program that could empower adolescents and youth counselors to address mental health concerns for a healthier community. The group identified and prioritized several key elements of an effective lay counselor intervention. CONCLUSIONS A diverse group of community stakeholders can illustrate critical mental health needs and elements that countries could use to adapt and contextualize a lay counsellor based mental health intervention for new populations such as the youth.
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Affiliation(s)
- Merrian J Brooks
- Botswana-UPenn Partnership, Gaborone, Botswana. .,Children's Hospital of Philadelphia, Buerger Center, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,University of Pennsylvania, Philadelphia, USA.
| | | | | | - Onkemetse Phoi
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.,Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Elizabeth Lowenthal
- Botswana-UPenn Partnership, Gaborone, Botswana.,Children's Hospital of Philadelphia, Buerger Center, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.,University of Pennsylvania, Philadelphia, USA
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Sequeira M, Singh S, Fernandes L, Gaikwad L, Gupta D, Chibanda D, Nadkarni A. Adolescent Health Series The status of adolescent mental health research, practice and policy in sub-Saharan Africa: A narrative review. Trop Med Int Health 2022; 27:758-766. [PMID: 35906997 PMCID: PMC9544168 DOI: 10.1111/tmi.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sub‐Saharan Africa (SSA) has the fastest growing adolescent population in the world. In addition to developmental changes, adolescents in SSA face health and socioeconomic challenges that increase their vulnerability to mental ill‐health. This paper is a narrative review of adolescent mental health (AMH) in SSA with a focus on past achievements, current developments, and future directions in the areas of research, practice and policy in the region. We describe the status of AMH in the region, critical factors that negatively impact AMH, and the ways in which research, practice and policy have responded to this need. Depression, anxiety and post‐traumatic stress disorders are the most common mental health problems among adolescents in SSA. Intervention development has largely been focused on HIV/AIDS service delivery in school or community programs by non‐specialist health workers. There is a severe shortage of specialised AMH services, poor integration of services into primary health care, lack of a coordinated inter‐sectoral collaboration, and the absence of clear referral pathways. Policies for the promotion of AMH have been given less attention by policymakers, due to stigma attached to mental health problems, and an insufficient understanding of the link between mental health and social determinants, such as poverty. Given these gaps, traditional healers are the most accessible care available to help‐seeking adolescents. Sustained AMH research with a focus on the socioeconomic benefits of implementing evidence‐based, contextually adapted psychosocial interventions might prove useful in advocating for much needed policies to improve AMH in SSA.
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Affiliation(s)
| | - Soumya Singh
- Addictions Research Group, Sangath, Porvorim, Goa, India
| | | | - Leena Gaikwad
- Addictions Research Group, Sangath, Porvorim, Goa, India
| | - Devika Gupta
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Dixon Chibanda
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Abhijit Nadkarni
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Brooks MJ, Willis N, Beji-Chauke R, Tshume O, Phoi O, Lowenthal E, Chibanda D, Ferrand RA. Principles for delivery of youth lay counsellor programs: Lessons from field experiences. J Glob Health 2022; 12:03047. [PMID: 35871402 PMCID: PMC9308976 DOI: 10.7189/jogh.12.03047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Merrian J Brooks
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Philadelphia, Pennsylvania, USA.,Botswana UPENN Partnership, Gaborone, Botswana
| | | | | | | | | | - Elizabeth Lowenthal
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dixon Chibanda
- Friendship Bench Zimbabwe, Harare, Zimbabwe.,London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
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Tran HV, Nong HTT, Tran TTT, Filipowicz TR, Landrum KR, Pence BW, Le GM, Nguyen MX, Chibanda D, Verhey R, Go VF, Ho HT, Gaynes BN. Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study. JMIR Form Res 2022; 6:e37211. [PMID: 35802402 PMCID: PMC9308082 DOI: 10.2196/37211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)–based program that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam. Objective This study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation) to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework. Methods The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and testing phases. Results The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final program manual. Conclusions This study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among people living with HIV on MMT in Vietnam. Trial Registration ClinicalTrials.gov NCT04790201; https://clinicaltrials.gov/ct2/show/NCT04790201
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Affiliation(s)
- Ha V Tran
- The University of North Carolina, Vietnam Office, Hanoi, Vietnam
| | - Ha T T Nong
- The University of North Carolina, Vietnam Office, Hanoi, Vietnam
| | - Thuy T T Tran
- Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Teresa R Filipowicz
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Kelsey R Landrum
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Giang M Le
- Center for Research and Training in HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
| | - Minh X Nguyen
- Faculty of Epidemiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Dixon Chibanda
- Department of Community Medicine & Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ruth Verhey
- Department of Community Medicine & Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Vivian F Go
- Department of Health Behavior, Gillings, School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Hien T Ho
- Faculty of Clinical Medicine, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
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Broström S, Johansson BA, Verhey R, Landgren K. "Seeing a Brighter Future" - Experiences of Adolescents with Common Mental Disorders Receiving the Problem-Solving Therapy "Youth Friendship Bench" in Zimbabwe. Issues Ment Health Nurs 2021; 42:1019-1029. [PMID: 34048312 DOI: 10.1080/01612840.2021.1924323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In Zimbabwe common mental disorders are prevalent among adolescents and the treatment gap is large. The recently introduced Youth Friendship Bench intervention (YouFB) addresses this gap by task-shifting youth lay health workers to offer a culturally contextualised, manual-based, six-session problem-solving therapy to adolescents, 16-19 years of age. The aim of this study was to explore participants´ experiences of YouFB to attain a first insight into this novel intervention. Interviews with nine adolescents were analysed using qualitative content analysis on a latent level. The experience of YouFB was positive, perceived to offer hope and relief from feelings of isolation and uncertainty, increase manageability of problems, and contribute to feelings of autonomy, resulting in a feeling of optimism about the future. The notion among participants that this brief intervention had such a positive influence on their lives, sparks interest because of its applicability in low-resource settings.
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Affiliation(s)
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden.,Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient, Care and Specialized Teams, Emergency Unit, Malmö University Hospital, Malmö, Sweden
| | | | - Kajsa Landgren
- Faculty of Medicine, Institute of Health Sciences, Lund University, Lund, Sweden.,Psychiatric Clinic in Lund, Office of Psychiatry and Habilitation, Region Skåne, Sweden
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