Charisse V. Ahmed

Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionate burden of gender-based violence (GBV), HIV risk, and mental health challenges. Despite the demonstrated effectiveness of psychological interventions such as problem-solving therapy (PST), there is limited evidence on culturally adapted models for GBV-exposed AGYW that concurrently address HIV and mental health, particularly in settings with constrained mental health infrastructure. Objective: This study outlines the protocol for a randomized controlled trial evaluating Mpata Yathu , a church-based adaptation of the Friendship Bench intervention, which delivers lay counselor-led PST to AGYW with a history of GBV in Lusaka, Zambia. Methods: A hybrid implementation-effectiveness type 1 randomized controlled trial (intervention and waitlist control arms) will be conducted among 90 AGYW, aged 15 to 24, per arm with moderate depressive symptoms, lifetime GBV exposure, and HIV risk or diagnosis. The intervention comprises six individual PST sessions delivered over 3 months in church spaces. Implementation outcomes (feasibility, acceptability, fidelity), common mental disorder (CMD) symptoms (primary outcome), and exploratory outcomes (depression, anxiety, PTSD, HIV engagement, GBV attitudes, childhood adversity, coping self-efficacy) will be assessed at baseline, 3, and 6 months. The trial is powered to detect changes in CMD symptoms only. Mixed-methods data will inform feasibility, intervention refinement, and hypotheses regarding mental health as a mediator of HIV outcomes. Process evaluations will use the Consolidated Framework for Implementation Research (CFIR). Conclusions: This trial will assess the potential of church-based PST to address the intersecting burdens of GBV, HIV, and mental health among AGYW in Zambia. Findings will offer insights into leveraging trusted community institutions (e.g., church and religious settings) for mental health and HIV care delivery in low-resource settings. Trial registration: ClinicalTrials.gov NCT07132905. Prospectively registered on August 13, 2025. clinicaltrials.gov/study/NCT07132905.

Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionate burden of gender-based violence (GBV), HIV risk, and mental health challenges. Despite the demonstrated effectiveness of psychological interventions such as problem-solving therapy (PST), there is limited evidence on culturally adapted models for GBV-exposed AGYW that concurrently address HIV and mental health, particularly in settings with constrained mental health infrastructure. Objective: This study outlines the protocol for a randomized controlled trial evaluating Mpata Yathu, a church-based adaptation of the Friendship Bench intervention, which delivers lay counselor-led PST to AGYW with a history of GBV in Lusaka, Zambia. Methods: A hybrid implementation-effectiveness type 1 randomized controlled trial (intervention and waitlist control arms) will be conducted among 90 AGYW, aged 15 to 24, per arm with moderate depressive symptoms, lifetime GBV exposure, and HIV risk or diagnosis. The intervention comprises six individual PST sessions delivered over three months in church spaces. Implementation outcomes (feasibility, acceptability, fidelity), common mental disorder (CMD) symptoms (primary outcome), and exploratory outcomes (depression, anxiety, PTSD, HIV engagement, GBV attitudes, childhood adversity, coping self-efficacy) will be assessed at baseline, 3, and 6 months. The trial is powered to detect changes in CMD symptoms only. Mixed-methods data will inform feasibility, intervention refinement, and hypotheses regarding mental health as a mediator of HIV outcomes. Process evaluations will use the Consolidated Framework for Implementation Research (CFIR). Conclusions: This trial will assess the potential of church-based PST to address the intersecting burdens of GBV, HIV, and mental health among AGYW in Zambia. Findings will offer insights into leveraging trusted community institutions (e.g., church and religious settings) for mental health and HIV care delivery in low-resource settings. Trial Registration Number:Pending. The study will be registered prospectively on ClinicalTrials.gov. The WHO Trial Registration Data Set will be completed and submitted with ClinicalTrials.gov registration prior to trial launch. Protocol version: July 2025, Version 1.0; this trial is projected to begin September 2025 and end April 2026

An evidence-based psychological intervention, known as Friendship Bench, for depression and anxiety was adapted among adolescents living with HIV (ALHIV) in Gaborone, Botswana, and renamed Safe Haven. The purpose of this study was to qualitatively describe the barriers and facilitators that influence the implementation of Safe Haven from the perspective of peer counselors delivering the intervention in Gaborone, Botswana. We conducted a secondary analysis using qualitative data from a pilot study to evaluate Safe Haven. Eight peer counselors participated in semi-structured interviews to describe their experiences with implementing Safe Haven during the pilot. We analyzed the interview data thematically using the Consolidated Framework for Implementation Research to guide theme development. We identified six barriers and two facilitators of Safe Haven implementation. The barriers were 1) client reticence and confidentiality concerns, 2) parent disapproval, 3) client accessibility, 4) counselor psychological wellbeing, 5) scheduling conflicts 6) limited financial resources for counselors. The facilitators were 1) peer delivery of counseling was deemed more acceptable among adolescents than counseling delivered by older adults, and 2) the counselors placed high value on the intervention. We found that parental disapproval and shared trauma among counselors and clients are key barriers that may negatively impact implementation outcomes such as sustainability and penetration. To improve accessibility of the intervention, peer counselors recommended implementation in school settings and to educate parents on mental health. Overall, the barriers and facilitators identified in our study can guide larger scale implementation of Safe Haven among ALHIV in resource-poor settings.

Despite widespread availability of life-saving antiretroviral therapy (ART) in sub-Saharan Africa, AIDS remains one of the leading causes of death among adolescents living with HIV (ALHIV) in sub-Saharan Africa. The purpose of this article was to review the state of the science regarding interventions to improve ART adherence and/or HIV care retention among ALHIV throughout sub-Saharan Africa. The primary aim of this review was to describe the impact of peer support interventions in improving treatment outcomes (i.e., ART adherence and retention in HIV care) among ALHIV in sub-Saharan Africa. The secondary aim of this review was to determine whether these interventions may be efficacious at improving mental health outcomes. We identified 27 articles that met the eligibility criteria for our review, and categorized each article based on the type of peer support provided to ALHIV—individualized peer support, group-based support, and individualized plus group-based support. Results regarding the efficacy of these interventions are mixed and most of the studies included were deemed moderate in methodological quality. Although studies evaluating group-based peer support interventions were the most common, most of these studies were not associated with retention, adherence, or mental health outcomes. More robust, fully powered studies are needed to strengthen our knowledge base regarding peer support for ALHIV.

We aimed to elucidate the specific roles and responsibilities of expert clients in service delivery among adolescents living with HIV in Eswatini, and to provide recommendations for enhancing adolescent service provision among expert clients and similar lay health workers throughout low- and middle-income countries. An exploratory qualitative descriptive methodology using conventional content analysis was used to meet our study aims. We recruited 20 expert clients and 12 key informants (programme managers, programme coordinators and nurses) to participate in semi-structured interviews, and we arranged four focus group discussions among adolescents living with HIV with seven to ten participants per focus group. Adherence counselling in clinical and community settings was considered paramount to the roles and responsibilities of expert clients with regard to adolescent-specific HIV service delivery. The following recommendations were made to enhance expert client service delivery practices among adolescents: (1) training in adolescent developmental, sexual and reproductive needs; (2) training to enhance clinical knowledge and skills; (3) additional work equipment and compensation; and d) more parent and guardian engagement in their work. While expert clients meet the needs of adolescents living with HIV in several capacities, they require additional resources, skills and training to improve their work, especially in the realm of sexual and reproductive health. Future research is needed to evaluate the impact of expert client service delivery on adolescent health outcomes.

Black youth face significant disparities in HIV/sexually transmitted infection (STI) disease burden. Mental illness and emotion regulation are ontributors to HIV/STI risk, yet many HIV/STI prevention interventions do not address these factors. Project GOLD was a pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention designed to address the role of mental illness and emotion regulation in HIV/STI risk among heterosexually active Black youth aged 14–17 (N = 108). Participants were recruited from outpatient mental health treatment programs and general community settings via community partner referrals, face-to-face encounters, flyers and social media. Assessments were conducted pretest, immediate posttest, and at 3-, 6-, and 12-month follow-up. Although there were no statistically significant differences in behavior change from baseline, there were practically significant effect sizes among HIV condition participants when compared to the general health condition (e.g., fewer sexual partners at 6 months). An increase in theoretical mediators (e.g., condom use negotiation beliefs) was sustained at 12 months. HIV condition participants also reported lower depressive symptom severity, with statistical significance noted at immediate post and at 3 months. The findings highlight the importance and challenges of engaging Black youth in culturally and contextually relevant, developmentally and psychologically appropriate HIV/STI prevention interventions.

BackgroundLike in other countries throughout sub-Saharan Africa, Eswatini employs a cadre of HIV-positive lay health workers known as expert clients (ECs) for the purpose of mitigating human resource gaps in HIV care. However, there are no insights in the literature describing the scope of their contribution to adolescent-specific HIV service delivery. Therefore, we aimed to elucidate the specific roles and responsibilities of ECs with regard to service delivery among adolescents living with HIV in Eswatini, and to provide recommendations for enhancing adolescent service provision among ECs and similar lay health workers throughout low- and middle-income countries. MethodsAn exploratory qualitative descriptive methodology using conventional content analysis was employed to meet our study aims. We recruited 20 expert clients and 12 key informants (i.e., program managers, program coordinators, and nurses) to participate in semi-structured interviews, and we arranged four focus group discussions among adolescents living with HIV with 7 to 10 participants per focus group. ResultsAdherence counseling in clinical and community settings was considered paramount to the roles and responsibilities of ECs with regard to adolescent-specific HIV service delivery. The following recommendations were made to enhance EC service delivery practices among adolescents: a) training in adolescent developmental, sexual, and reproductive needs, b) training to enhance clinical knowledge and skills, c) additional work equipment and compensation, and d) more parent and guardian engagement in their work. ConclusionsWhile expert clients meet the needs of HIV-positive adolescents in several capacities, ECs require additional resources, skills, and training to improve their work, especially within the realm of sexual and reproductive health. Future research is needed to evaluate the impact of EC service delivery on adolescent health outcomes.

Although early antiretroviral therapy (ART) reduces HIV-related mortality in children by up to 75%, almost half of HIV-positive children younger than 1 year old in Swaziland do not initiate ART. This study was conducted to identify barriers to early ART initiation among HIV-positive infants. This was a case-control study among HIV-positive infants, aged 2 to 18 months, who either did not initiate ART (cases), or initiated ART (controls), during 18 months after testing. Multivariable logistic regression showed that infants who visited the clinic every month, or every 2 months, were 5.78 and 6.20 times more likely to initiate ART than those who visited less often (OR 5.78, 95% CI 1.82–18.33 and OR 6.20, 95% CI 1.30–29.60 respectively). Children who lived ≤30 and 31–60 minutes from the nearest clinic were 84% and 79% less likely respectively to initiate ART (OR 0.16, 95% CI 0.03–0.78 and OR 0.21, 95% CI 0.04–0.98) compared with those who lived more than 60 minutes away. Children who received immunisation aft...