Friendship Bench trial: lay worker training in problem-solving therapy to reduce symptoms of common mental disorders

The Friendship Bench trial is a cluster-randomised trial of the effect of problem-solving therapy training for lay workers on symptoms of common mental disorders among clinic attenders in Harare, Zimbabwe. This dataset enables replication of analysis for a paper on suicidal ideation, but has undergone anonymisation process to protect study participants. 12 primary care clinics in Harare were randomised 1:1 to intervention or control. In each clinic, 24 participants were enrolled who were: visiting the clinic (either for their own health needs or accompanying someone else); aged 18 or over; living locally; and screened positive for common mental disorder symptoms. Outcomes were measured after 6 months. 86% of participants were women, 42% were HIV positive and 91% completed follow-up

Trained lay health workers reduce common mental disorder symptoms of adults with suicidal ideation in Zimbabwe: a cohort study.

BACKGROUND: Suicidal ideation may lead to deliberate self-harm which increases the risk of death by suicide. Globally, the main cause of deliberate self-harm is depression. The aim of this study was to explore prevalence of, and risk factors for, suicidal ideation among men and women with common mental disorder (CMD) symptoms attending public clinics in Zimbabwe, and to determine whether problem solving therapy delivered by lay health workers can reduce common mental disorder symptoms among people with suicidal ideation, using secondary analysis of a randomised controlled trial. METHODS: At trial enrolment, the Shona Symptom Questionnaire (SSQ) was used to screen for CMD symptoms. In the intervention arm, participants received six problem-solving therapy sessions conducted by trained and supervised lay health workers, while those in the control arm received enhanced usual care. We used multivariate logistic regression to identify risk factors for suicidal ideation at enrolment, and cluster-level logistic regression to compare SSQ scores at endline (6 months follow-up) between trial arms, stratified by suicidal ideation at enrolment. RESULTS: There were 573 participants who screened positive for CMD symptoms and 75 (13.1%) reported suicidal ideation at baseline. At baseline, after adjusting for confounders, suicidal ideation was independently associated with being aged over 24, lack of household income (household income yes/no; adjusted odds ratio 0.52 (95% CI 0.29, 0.95); p = 0.03) and with having recently skipped a meal due to lack of food (adjusted odds ratio 3.06 (95% CI 1.81, 5.18); p < 0.001). Participants who reported suicidal ideation at enrolment experienced similar benefit to CMD symptoms from the Friendship Bench intervention (adjusted mean difference - 5.38, 95% CI -7.85, - 2.90; p < 0.001) compared to those who had common mental disorder symptoms but no suicidal ideation (adjusted mean difference - 4.86, 95% CI -5.68, - 4.04; p < 0.001). CONCLUSIONS: Problem-solving therapy delivered by trained and supervised lay health workers reduced common mental disorder symptoms among participants with suicidal thoughts who attended primary care facilities in Zimbabwe. TRIAL REGISTRATION: pactr.org ldentifier: PACTR201410000876178

Effect of a brief psychological intervention for common mental disorders on HIV viral suppression: A non-randomised controlled study of the Friendship Bench in Zimbabwe.

BackgroundFor people living with co-morbid HIV and common mental disorders (CMD), it is not known whether a brief psychological intervention for CMD can improve HIV viral suppression.MethodsWe conducted a prospective cohort study in eight primary care clinics in Harare, Zimbabwe, enrolling adults with co-morbid HIV and CMD. Six clinics provided the Friendship Bench (FB), a brief psychological intervention for CMD based on problem-solving therapy, delivered by lay counsellors. Two clinics provided enhanced usual care (EUC). The primary outcome was viral non-suppression after six months (viral load ≥400 copies/mL). Data were analysed using a difference-in-difference approach with linear regression of cluster-level proportions, adjusted for baseline viral non-suppression (aDiD). The secondary outcome was presence of CMD measured by the Shona Symptom Questionnaire.ResultsIn FB clinics, 407/500 (81.4%) participants had viral load results at baseline and endline: 58 (14.3%) had viral non-suppression at baseline and 41 (10.1%) at endline. In EUC clinics, 172/200 (86.0%) had viral load results at baseline and endline: 22 (12.8%) were non-suppressed at baseline and 26 (15.1%) at endline (aDiD = -7.3%; 95%CI 14.7% to -0.01%; p = 0.05). Of the 499 participants virally suppressed at baseline, the FB group had lower prevalence of non-suppression at endline compared to the EUC group (2.9% vs 9.3%; p = 0.002). There was no evidence of a difference in endline viral non-suppression by group among the 80 participants with non-suppression at baseline (53.5% vs 54.6%; p = 0.93). The FB group was less likely to screen positive for CMD at endline than the EUC group (aDiD = -21.6%; 95%CI -36.5% to -6.7%; p = 0.008).ConclusionPeople living with co-morbid HIV and CMD may benefit from receiving a low-cost mental health intervention to enhance viral suppression, especially if they are already virally suppressed. Research is needed to understand if additional adherence counselling could further improve viral suppression

Viral non-suppression at follow-up by treatment group stratified according to baseline viral load.

Results are difference-in-difference of proportions in viral non-suppression between groups from baseline to follow-up.</p

Associations between baseline characteristics and completeness of viral load (VL) data presented as ORs with corresponding p-values from individual-level logistic regression analyses.

Associations between baseline characteristics and completeness of viral load (VL) data presented as ORs with corresponding p-values from individual-level logistic regression analyses.</p

Participants living with HIV and CMD recruited into the study between August 2017 and July 2018.

Participants living with HIV and CMD recruited into the study between August 2017 and July 2018.</p

Baseline characteristics of 579 participants with viral load testing at baseline and follow-up according to treatment group.

Baseline characteristics of 579 participants with viral load testing at baseline and follow-up according to treatment group.</p

Associations between baseline characteristics and treatment group (exposure) or viral non-suppression at endline (outcome) presented as ORs with corresponding p-values from individual-level logistic regression analyses.

Associations between baseline characteristics and treatment group (exposure) or viral non-suppression at endline (outcome) presented as ORs with corresponding p-values from individual-level logistic regression analyses.</p

Proportion of patients with viral non-suppression at baseline and six months follow-up by clinic.

Proportion of patients with viral non-suppression at baseline and six months follow-up by clinic.</p