Addressing Intimate Partner Violence, Mental Health, and HIV in Antenatal Care

Pilot Intervention for Addressing Intimate Partner Violence, Mental Health, and HIV in Antenatal Care

This quasi-experimental feasibility study recruit n=40 participants from each of two public antenatal clinics in Johannesburg, South Africa. Using the Bowen et al. approach, key feasibility study questions will be those around acceptability, implementation, and promising effects on intermediate variable. While this pilot trial is not powered to determine efficacy, it can help establish whether intervention targets the appropriate intermediate mechanisms (i.e. primary endpoints of IPV exposure and depressive symptoms) and moves intended outcomes in the right direction (i.e. towards better adherence as measured by self-reported adherence).

Prevention of mother-to-child transmission (PMTCT) programs are effective if women take medication regularly, yet many perinatal women in sub-Saharan Africa have sup-optimal adherence. Intimate partner violence (IPV) worsens women's ability to adhere to antiretroviral therapy (ART), and leads to higher rates of depression. In a quasi-experimental feasibility study in South Africa, 2 inner-city Johannesburg clinics will be assigned to intervention or enhanced standard of care conditions. Intervention consists of training health workers to deliver one-on-one sessions in pregnancy (4 sessions) and postpartum (2 sessions) using problem-solving therapy and safety planning. Following n=80 women in a prospective cohort will allow for preliminarily assessment of intervention effects on: perinatal depression, IPV exposure, and ART adherence at 6 months postpartum. Additional qualitative research with 10 providers and 15 beneficiaries will help us qualitatively assess acceptability of intervention content, measures, and study conditions. This pilot trial can establish acceptability of intervention and control conditions and provide preliminary point estimates to inform future trial design.

Inclusion Criteria:

• 18 years or older (the age of research consent in South Africa)
• currently pregnant and less than 30 weeks gestation (from antenatal green card)
• speak a study language (English, isiZulu, Sesotho)
• living with HIV (self-reported and confirmed on green card)
• report past-year IPV (score of ≥1 on WHO multicountry study instrument)
• are willing to provide informed consent

Exclusion Criteria:

• fail to meet all of the inclusion criteria
• at risk of immediate danger (current suicidality, homicidality, or risk to child safety)
• planning to terminate the pregnancy