Speakers
Description
Introduction: Pregnant and Postpartum Women living with HIV (PPWH) face elevated risks of mental health challenges, which can impede engagement in HIV care. This study assessed the acceptability, feasibility and fidelity of the WHO's Problem Management Plus (PM+) intervention adapted for PPWH, delivered in-person and via mobile phone, in a resource-limited setting.
Methods: This cross-sectional study analyzed baseline data from 120 participants in the TATUA pilot study in Kisumu, Kenya, enrolled in March -August 2024. TATUA aims to evaluate the impact of PM+ to prevent care disengagement and viral failure among PPW. PM+ is an evidence-based psychosocial intervention delivered by trained lay health workers in weekly sessions. Participants at risk for care disengagement and viral failure based on a risk calculator developed in this study were enrolled and randomized 1:1:1 to the standard of care (N=40), 5 session in-person PM+ (N=40) and 10 session mobile PM+ (N=40) arms. Acceptability was assessed through structured surveys administered at three and six months postpartum, feasibility was evaluated based on recruitment and retention rates; and fidelity was measured by intervention coverage and session completion timelines.
Results: Among the 80 participants randomized to a PM+ arm (mean age 30, Standard Deviation =7), most were married (78%), 48% had attained secondary level education, and 5% were formally employed. Acceptability was high in both in-person and mobile delivery arms, with >95% coverage and >98% reporting positive experiences at both 3 and 6 months. Feasibility was demonstrated by a 94% enrolment rate of those eligible and 95% PM+ session completion. While fidelity was high in both arms, timely completion of all sessions was more common in the in-person arm (42.1%) than mobile (13.2%). Most participants reported improved mental health (100% at 3 and 6 months) and HIV care engagement (97% at 3 months and 100% at 6 months) with minimal disruption to daily responsibilities.
Conclusion: These findings highlight the adaptability of PM+ intervention, while pointing out the importance of addressing real-world implementation considerations in future scale-up efforts. PM+ demonstrates strong feasibility and acceptability in supporting mental health and HIV care engagement among PPWH. While the potential for scalability through mobile delivery offers a promising avenue for broader implementation and increased reach in diverse settings, there is need for greater flexibility for timely completion of the sessions.
Key words: Problem management plus, acceptability, fidelity, feasibility
References
1. Chibanda D, Shetty AK, Tshimanga M, Woelk G, Stranix-Chibanda L, Rusakaniko S. Group problem-solving therapy for postnatal depression among HIV-positive and HIV-negative mothers in Zimbabwe. J Int Assoc Provid AIDS Care. 2014;13(4):335-341.
