Acceptability and Feasibility of Group Interpersonal Therapy (IPT-G) for Depressed HIV+ Postpartum Adolescents Delivered by Community Health Workers: A Protocol Paper

Abstract

Introduction: Postpartum depression affects mothers at 4 to 6 weeks after delivery. Adolescent pregnancy can lead the expectant girl to drop out of school, receive poor obstetric care, and family support. Adolescent mothers are prone to severe postpartum depression as compared to older women. Early sexual initiation increases the risk of unintended pregnancies and potentially increases HIV exposure. WHO recommends Group interpersonal psychotherapy (IPT-G) as an evidence-based intervention for use in both primary care and community settings. We will assess the acceptability and feasibility of community health workers (CHWs), delivering IPT-G among postpartum adolescents (PPA) living with HIV. Method: This is a pilot feasibility study testing CHWs’ delivery of IPT-G to postpartum adolescents and young women living with HIV who will be attending the prevention of mother-to-child HIV transmission (PMTCT) clinics in 2 primary care health centers. Young women aged 15 to 24 years and 6 to 12 weeks postpartum will be eligible for participation. Our study is a two-arm intervention implementation study with one receiving group IPT and another one treatment-as-usual (TAU). We intend to treat the TAU group so that we will offer IPT-G post-intervention. There will be 2 groups running in the 2 facilities. Depression will be assessed using the Edinburgh postnatal depression scale (EPDS); those with EPDS >10 become eligible for the intervention. Besides, HIV-related stigma would be screened using HIV/AIDS Stigma Instrument (HASI–P), and social functioning rated using the World Health Organization’s Disability Assessment Schedule 2.0 (WHODAS 2.0). CHWs will deliver IPT-G for 8 sessions (1 session per week). The intervention group will receive immediate IPT-G, and the wait-list control group will receive deferred IPT-G as part of our intent to treat the group. Primary outcome measure and analysis: Descriptive statistics will be used to compare changes in depressive symptoms, HIV-related stigma, and social functioning between baseline and 8 weeks, and between 16 weeks and 24 weeks. The changes will be explored along with the differences between intervention and treatment as usual groups reporting effect sizes (Cohen’s d). Longitudinal continuous outcome variables across the time points will be analyzed using the Generalized Linear Model. For qualitative data, any emerging themes from KIIs and FGDs will be identified: framework matrixes, queries, and cross-tabulations will be used to analyze and interpret the data in view of assessing acceptability and feasibility of IPT-G. Ethics and dissemination The Kenyatta National Hospital-University of Nairobi approved this study of Nairobi Ethics and Research Committee (Approval No. P97/02/2018). The findings will be published in peer-reviewed journals and also shared with Kenya’s National AIDS Control Council.