Implementation Determinants of Problem-Solving Therapy Delivered by Near-Peer Lay Counselors for Youth Living with HIV in Botswana: Lay Counsellor Perspectives

Abstract

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.