Addressing Perinatal Depression and PMTCT Adherence in Malawi: A Couple-Based Approach

What this Trial Is About

Researchers are evaluating a new approach to help women living with HIV who are experiencing depression during pregnancy and after childbirth in Malawi. The study focuses on improving adherence to prevention of mother-to-child transmission (PMTCT) of HIV, which involves taking antiretroviral therapy, infant prophylaxis, and exclusive breastfeeding. Depression during this period often leads to poor adherence and ongoing HIV presence in mothers. This trial aims to develop and test a couple-based intervention that strengthens partner support, communication, and problem-solving skills to address depression and improve PMTCT adherence. The study compares two groups: one receiving standard care, including regular HIV and perinatal care with referrals for depression services, and the other receiving a couples-based intervention adapted from the World Health Organization's Problem Management Plus (PM+) program. This intervention consists of five sessions covering stress management, problem-solving, behavioral activation, and skills to enhance social support and couple communication. Special emphasis is placed on addressing food insecurity, a major issue for participants, by helping couples brainstorm solutions related to nutrition and access to food. Participants will engage in the intervention over about five months, with follow-up continuing for roughly eleven months to assess participation, retention, intervention quality, and acceptability. Researchers will measure changes in depression symptoms, viral suppression, adherence to antiretroviral therapy and infant prophylaxis, infant HIV testing, and breastfeeding practices at three and six months postpartum. The study takes place within antenatal and HIV care settings, offering a comprehensive evaluation of this novel couple-based support approach.

Prevention of Mother-to-child Transmission (PMTCT) Among Women Experiencing Depression in Malawi