Lessons From Implementing Ask-Boost-Connect-Discuss, a Peer-Delivered Psychosocial Intervention for Young Mothers Living With HIV in Malawi, Tanzania, Uganda, and Zambia

• Authors: Christina Laurenzi, Stellenbosch University; Don Operario, Emory University; Chipo Mutambo, Paediatric-Adolescent Treatment Africa, Cape Town; Eugene Mupakile, Paediatric-Adolescent Treatment Africa, Lusaka; Blessings Banda, Paediatric-Adolescent Treatment Africa, Lilongwe; Fileuka Ngakongwa, Paediatric-Adolescent Treatment Africa, Dar es Salaam; Richard Kilonzo, Paediatric-Adolescent Treatment Africa, Kampala; Chuma Busakhwe, University of Cape Town; Agnes Ronan, Paediatric-Adolescent Treatment Africa, Cape Town; Elona Toska, University of Cape town
• Journal Title: Global Health: Science and Practice
• Volume: Volume 11, Number 5
• Publisher: Johns Hopkins Center for Communication Programs | 2023-10-30, Pages e2300077-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.9745/GHSP-D-23-00077
• Subjects: Health Sciences, Public Health
• Keywords: Adolescent girls; HIV; Ask-Boost-Connect-Discuss

Abstract

Adolescent girls and young women in sub-Saharan Africa are at high risk of HIV, unintended pregnancy, and early motherhood. These intersecting risks can adversely affect their developmental trajectories and lifelong well-being. Because young mothers living with HIV in these settings experience high levels of stigma, shame, and isolation, tailored psychosocial intervention approaches for this group are critical yet unavailable. Enlisting young peer supporters may be a promising way to expand the reach of health services and enhance psychosocial well-being. To date, few peer-based interventions have targeted young mothers living with HIV. In 2019–2021, we codeveloped a peer-based, facility-embedded intervention package, Ask-Boost-Connect-Discuss (ABCD), with young peer supporters to address the psychosocial needs of young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia. We then analyzed programmatic data from ABCD to assess the feasibility of using young peers to deliver psychosocial support. Data sources included post-intervention interviews, focus groups, and written feedback from multiple stakeholders (participants, peer supporters, their supervisors, and clinic-based mentors), which were analyzed thematically. We organized our findings according to Bowen et al.'s feasibility framework. Findings spoke to the acceptability, practicality, and integration of the ABCD program. We found that young peer supporters were seen as acceptable program implementers; able to adopt responsive, engaging, and nonjudgmental approaches; and supported through training, technical skills development, and supervision, alongside purposeful facility integration. Importantly, we also found evidence reflecting the roles of demand and adaptation in program delivery (i.e., how peers responded to emerging participant needs or pivoted in their approach based on shifting circumstances). We conclude that considerations of intervention feasibility and/or program fidelity should be attuned to the dynamic qualities of young peer supporters as implementers and should extend beyond standard modes of assessment to consider intervention codevelopment and implementation as an iterative and adaptive process.