Speaker
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Background: In Kenya, mentor mothers (MMs) are lay health workers with lived experience who provide psychosocial peer support to women newly diagnosed with HIV and may have the potential to be key contributors to the mental health workforce. Prior studies have documented the successful delivery of psychosocial interventions by lay health workers, including the World Health Organization endorsed Problem Management Plus (PM+) - a problem-solving intervention that integrates behavioral strategies to reduce concerns and emotional problems. MMs’ trusted relationships with HIV-positive peers and contextual understanding of mental health needs and HIV-related stigma uniquely position them to support perinatal women with HIV (PWWH), who face elevated risk for common mental disorders (CMDs). However, concerns remain regarding MMs’ limited formal training and capacity to deliver structured mental health interventions. To address these gaps, we developed Tunawiri, a Collaborative Care Model that integrates mental health services into routine antenatal and HIV care at health facilities in Kenya, including delivery of PM+ sessions by mentor mothers. Prior to implementation, the current study examined the feasibility, acceptability, and capacity building needs of MMs to take on this role.
Methods: We conducted multi method data collection with stakeholders in the Kisumu County health system between January-September 2024. Focus group discussions (n=48) were conducted with PWWH with probable CMDs (2 groups), peer mentor mothers (2 groups), and clinical staff and managers (2 groups). A total of 20 in-depth interviews done with key informants, including representatives from the County and National Ministry of Health. Audio recordings were transcribed using Otter, then coded and analyzed using Dedoose, utilizing thematic analysis. Findings from the qualitative and organizational readiness research were presented to the study’s external advisory board, which helped refine and finalize implementation strategies focused on building the capacity of mentor mothers to support PWWH.
Results: Participants identified structural barriers, including low mental health awareness, inconsistent screening, weak referral systems, and a shortage of mental health clinicians, MMs were recommended as an integral partner in supporting the mental health and wellbeing of PWWH. Participants noted their potential to play a multifaceted role in supporting the Collaborative Care Model; acting as educators, messengers, counselors, and advocates for mental health promotion. Potential barriers to working with MMs in this role included lack of formal training and expertise, inability to handle difficult cases and literacy. Proper supervision by clinical staff (nurses) who provide technical support and capacity building through intensive structured training (basic counseling skills, PM+ intervention, case management scenarios) and guidelines (role and duty expectations of MMs) were emphasized as steps to implement the Collaborative Care Model to ensure the successful delivery of the PM+ component by MMs.
Conclusion: MMs appear to be an acceptable and feasible cadre of workers to collaborate with other health workers in integrating mental health services into ANC/HIV clinics in Kenya. Capacity building of this cadre to deliver mental health interventions can help to promote the mental and physical health of PWWH and their families.
