Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study (Preprint)

Abstract

BACKGROUND Prevalence of common mental disorders (CMDs) among people living with HIV (PWH) and people who inject drugs (PWID) is high globally and in Vietnam. Yet, few evidence-based CMD interventions for PWH who inject drugs have been adapted for use in Vietnam. We adapted the “Friendship Bench” (FB), a problem-solving therapy (PST)-based intervention which was successfully implemented among CMD patients in primary health settings in Zimbabwe and Malawi for use among PWH on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam. OBJECTIVE This manuscript describes the adaptation process, with a detailed presentation on four phases from the third (adaptation) to the sixth (integration) of the ADAPT-ITT (Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing) framework. METHODS The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators and barriers towards conducting FB for PLWH on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original intervention manual and developed illustrated PST cases. In the topical expert and integration phases, two investigators and three subject matter experts reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft intervention will be used in the training and testing phases. RESULTS The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective intervention for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB intervention implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the intervention manual while maintaining the core components of PST of the original intervention throughout counseling techniques in all intervention sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final intervention manual. CONCLUSIONS This study successfully illustrates the process of operationalizing the ADAPT-ITT framework to adapt a mental health intervention in Vietnam. The study selected and culturally adapted an evidence-based PST intervention to improve CMDs among PWH on MMT in Vietnam. This adapted intervention has the potential to effectively address CMDs among PWH on MMT in Vietnam. CLINICALTRIAL The study protocol, available at clinicaltrials.gov (NCT04790201), was approved by The University of North Carolina at Chapel Hill and Hanoi Medical University IRBs. All study participants provided written informed consent in Vietnamese.