Friendship Bench Intervention reduces depression among HIV Pregnant women- UNC Project Study

Periscope Study team with UNC Project 
Country Director

Use of Friendship Bench mental health intervention has demonstrated to be effective in reducing depression among pregnant women living with HIV and help them adhere to HIV care.

The Periscope Study by UNC Project conducted between 2019 and 2022 targeting 80 participants, investigated the Adaptation of the Friendship Bench Mental Health Intervention for HIV-Infected Perinatal Women in Malawi.

When releasing the results on Monday in Lilongwe, the study coordinator Steve Mphonda, said counseling and support to stay engaged in HIV care helped to improve women’s mental health and engagement in HIV care.

He said these results are key since many pregnant and postpartum women living with HIV experience feelings of sadness or depression which makes it difficult to remain engaged in HIV care.

“Antenatal clinics in Malawi do not screen pregnant women on mental health disorders. Equally, major concern by our health facilities when it comes to pregnant women who are living with HIV, is about their HIV status and their physical health and are mostly provided with counselling on ART. So, the objective of the study was to adapt and enhance the Friendship Bench and assess its feasibility, fidelity of delivery, and acceptability in addressing Perinatal Depression (PND) and HIV care engagement among perinatal HIV-infected women.” He said

Steve Mphonda-Study Coordinator

The study coordinator, explained that PND which occur during pregnancy or six months after delivery, may adversely affect women’s mental health and physical health.

“Literature has shown that perinatal depression is common but unfortunately, women don’t get the care that they need. This is exactly why this study was important.” He added

Participants in the study were pregnant HIV positive women aged between 18 and above who were screened using self-reporting questionnaire (SRQ20) and were found to have depression.

Out of 80 participants, 40 received Friendship Bench support while the other 40 received usual care.

“The outcome showed that women in the Friendship Bench arm were more engaged in HIV care and had improvement in depressive symptom remission than those in Usual Care arm. In summary, the Friendship Bench counselling or psychosocial counselling is very important intervention that can help HIV positive women who are pregnant or they are breastfeeding because these women have a lot of issues and they need to be supported.” said Mphonda

He explained that Friendship Bench is a problem-solving therapy where a service provider teach client set of skills for solving their own problems.

“Once you teach a woman and you equip her with those skills, then definitely any problem that comes to her, she will be able to handle following the steps learned. For example, [pregnant] women come with a lot of issues like marital issues, economic issues, fights in the family, lack of food and school fees for children, or the child is problematic and is causing troubles at home, now with Friendship Bench a woman can have skills to solve those problems. That’s how best the problem-solving therapy and Friendship Bench is.” Shared Mphonda

One of the research team member from US, Prof. Angela Bengston, said the study presents better intervention for PND and improving engagement in HIV care as some studies have shown that up to 30% of Malawian women in the Option B+ program are lost to HIV care within 6 months of starting ART.

“We know that for people who are living with HIV, generally there are high levels of depression whether or not they are pregnant person. So, we have seen that there are high levels of perinatal depression among women living with HIV than those that are not.” Said Prof. Bengston

According to Prof. Bengston, the study which was a pilot trial has further shown high levels of feasibility to Malawian setting, acceptability among the participants and fidelity.

“And we want to scale it up and be evaluated in a larger trial. Our eventual hope is that something like Friendship Bench could be integrated into routine antenatal care that we could screen women for depression and that we could have a system for referring and providing psychosocial support and counselling through an intervention like the Friendship Bench.” Said Prof. Bengston

Michael Udedi

On his part, Dr. Michael Udedi, Assistant Director of Curative and Medical Rehabilitation Services responsible for Mental Health in the Non-Communicable Diseases and Mental Health Division in the Ministry of Health hailed the study for demonstrating possibility to integrate mental health care management in mothers who are attending antenatal and postnatal care.

“They can be engaged as well as returned to care but also their mental health outcomes can be improved by effective mental health care such as the Friendship Bench counselling or what we call problem solving therapy.” He said

Dr. Udedi concurred that during pregnancy, women experience a lot of stress which lead them to mental health problems.

“Looking at statistics out there from different studies, we have seen that those mothers who are attending antenatal care 11 percent experience mental health problems such as depression. Also, those mothers who have delivered, about 14 percent tend to have mental health issues such as depression or anxiety.” Dr. Udedi shared

But, he indicated that reproductive health department has integrated mental health as part of antenatal care which is a crucial in screening and provision of care to mothers.

Engagement in HIV care among pregnant women by addressing barriers is key to sustaining and building on the success of Option B+ and achieve UNAIDS 2025 AIDS Targets.

According to Mphonda, Friendship Bench can be applied in different settings as UNC Project has previously done studies that used Friendship Bench in areas of adult HIV clinics and NCD (Non-Communicable Disease) clinics.

“For example, in Zimbabwe they used Friendship Bench in the general population. So Friendship Bench is an intervention that can be used in any setting, and it is actually cheaper because it uses task-shifting approach where instead of professionals, you can train lay people to be Friendship Bench counsellors.” He said

He assured that this could be a solution to Malawi which currently has few mental health professionals as compared to the people who need the service.

“Friendship Bench is one way to reach out to more people who need mental health services. At the health facility for example, we can have Friendship Bench counsellors to help people coming for OPD to be assessed. So, if the nurses and clinicians are taught how to screen patients for depression then definitely, every patient that goes into the consultation room will be screened and those who have depression will be referred to Friendship Bench counsellors based at the facility. So, you can train nurses, HSAs and data clerks to be Friendship Bench counsellors.” Mphonda explained