Enhanced Problem-solving Therapy and HIV Engagement Support to Improve Perinatal Mental Health & HIV Outcomes in Malawi

NCT ID: NCT06702722

Last Updated: 2025-03-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-26

Study Completion Date

2028-06-30

Brief Summary

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The main objective of the proposed study is to evaluate the effectiveness of the Enhanced Friendship Bench intervention to improve perinatal depression, HIV care engagement, and infant health outcomes among pregnant women with HIV and depression in Malawi.

Detailed Description

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In our R34 pilot trial, the Enhanced Friendship Bench intervention showed strong feasibility, acceptability, fidelity, and preliminary effectiveness to improve perinatal depression and engagement in HIV care. The goal of this proposal is to evaluate the effectiveness of the Enhanced Friendship Bench in a fully powered randomized control trial to improve perinatal depression, HIV care engagement, and infant health outcomes, examine mediators and moderators that help elucidate mechanisms of action, and collect key implementation measures to accelerate the translation of findings into practice.

Conditions

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HIV Depression Depression, Postpartum

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

2-arm individually randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Enhanced Friendship Bench

Friendship Bench problem-solving therapy, social support sessions and home visits during the 3rd trimester as well as postpartum.

Group Type EXPERIMENTAL

Enhanced Friendship Bench

Intervention Type BEHAVIORAL

Friendship Bench problem-solving therapy involving 4 prenatal and 2 postnatal counseling sessions, enhanced for HIV care engagement with 2 social support building sessions and monthly home visits for ART delivery and counseling during the 3rd trimester and the first 3 months postpartum.

Enhanced usual care

Continue with usual outpatient care, enhanced to provide a mental health evaluation; brief supportive counseling; information, education, and support on common mental disorders; and (if indicated) facilitation of referral for further follow-up at a mental health clinic or psychiatric unit.

Group Type ACTIVE_COMPARATOR

Enhanced usual care

Intervention Type BEHAVIORAL

Usual care for mental health in public facilities in Malawi includes options for basic supportive counseling by a primary provider or nurse, medication management by the primary provider (amitriptyline is the one antidepressant typically available at primary health centers and is rarely prescribed for depression), referral to the clinic psychiatric nurse or mental health clinic, or in more severe cases referral to the psychiatric units at tertiary care hospitals. For the proposed study, usual care will be enhanced to provide a mental health evaluation; brief supportive counseling; information, education, and support on common mental disorders; and (if indicated) facilitation of referral for further follow-up at a mental health clinic or psychiatric unit.

Interventions

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Enhanced Friendship Bench

Friendship Bench problem-solving therapy involving 4 prenatal and 2 postnatal counseling sessions, enhanced for HIV care engagement with 2 social support building sessions and monthly home visits for ART delivery and counseling during the 3rd trimester and the first 3 months postpartum.

Intervention Type BEHAVIORAL

Enhanced usual care

Usual care for mental health in public facilities in Malawi includes options for basic supportive counseling by a primary provider or nurse, medication management by the primary provider (amitriptyline is the one antidepressant typically available at primary health centers and is rarely prescribed for depression), referral to the clinic psychiatric nurse or mental health clinic, or in more severe cases referral to the psychiatric units at tertiary care hospitals. For the proposed study, usual care will be enhanced to provide a mental health evaluation; brief supportive counseling; information, education, and support on common mental disorders; and (if indicated) facilitation of referral for further follow-up at a mental health clinic or psychiatric unit.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Presenting for antenatal care at one of our 5 recruitment sites
* ≥ 18 years of age
* ≤ 34 weeks gestation
* HIV-positive, based on medical records
* Initiating, re-initiating, or on established ART during index pregnancy
* Elevated depressive symptoms as indicated by a EPDS score ≥10. The EPDS is widely used to assess perinatal mood disorders that has been validated in perinatal populations in Malawi with this cut point to identify probable perinatal depression

Exclusion Criteria

* Suicidal ideation evaluated as acute risk.
* Other health concerns requiring emergent response.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Brian Pence, PhD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of North Carolina, Chapel Hill

Locations

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Area 18 Health Center

Lilongwe, , Malawi

Site Status NOT_YET_RECRUITING

Area 25 Health Center

Lilongwe, , Malawi

Site Status RECRUITING

Bwaila Hospital

Lilongwe, , Malawi

Site Status RECRUITING

Kawale Health Center

Lilongwe, , Malawi

Site Status RECRUITING

Likuni Mission Hosptial

Lilongwe, , Malawi

Site Status RECRUITING

Countries

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Malawi

Central Contacts

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Brian Pence, PhD, MPH

Role: CONTACT

1-919-966-7446

Angela Bengtson, PhD, MA

Role: CONTACT

Facility Contacts

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Steve Mphonda

Role: primary

265-1755056

Steve Mphonda

Role: primary

265-1755056

Steve Mphonda

Role: primary

265-1755056

Steve Mphonda

Role: primary

265-1755056

Steve Mphonda

Role: primary

265-1755056

Other Identifiers

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R01MH134660

Identifier Type: NIH

Identifier Source: secondary_id

View Link

24-0690

Identifier Type: -

Identifier Source: org_study_id

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