Reducing HIV‐related risk and mental health problems through a client‐centred psychosocial intervention for vulnerable adolescents in Addis Ababa, Ethiopia

Abstract

IntroductionEthiopia is experiencing an increasingly urban HIV epidemic, alongside a rise in urban adolescent migration. Adolescent migrants are often confronted by unique social challenges, including living in a difficult environment, abuse and mental health problems. These issues can increase adolescents’ vulnerability to HIV and compromise their capacity to protect themselves and others from HIV. We piloted and assessed the effects of a targeted psychosocial intervention to reduce mental health problems and improve HIV-related outcomes among migrant adolescents in Addis Ababa.MethodsA pre- and post-comparison design was used in a cohort of 576 female and 154 male migrant adolescents aged 15 to 18 years in Addis Ababa receiving services from two service delivery organizations, Biruh Tesfa and Retrak. We implemented a three-month client-centred, counsellor-delivered psychosocial intervention, based on findings from formative research among the same target population, to address participants’ increased vulnerability to HIV. The intervention package comprised individual, group and creative arts therapy counselling sessions. Key outcome indicators included anxiety, depression, aggressive behaviour, attention problems, social problems, knowledge of HIV, safer sex practices and use of sexual health services. Longitudinal data analysis (McNemar test and random effects regression) was used to assess changes over time in key indicators by gender.ResultsFor females, aggressive behaviour decreased by 60% (adjusted odds ratio (AOR): 0.4 (0.25 to 0.65)) and any mental health problem decreased by 50% (AOR: 0.5 (0.36 to 0.81)) from baseline to end line. In addition, knowledge of HIV increased by 60% (AOR: 1.6 (1.08 to 2.47)), knowledge of a place to test for HIV increased by 70% (AOR: 1.7 (1.12 to 2.51)) and HIV testing increased by 80% (AOR: 1.8 (1.13 to 2.97)). For males, HIV knowledge increased by 110% (AOR: 2.1 (1.1 to 3.94)), knowledge of a place to test for HIV increased by 290% (AOR: 3.9 (1.02 to 14.9)), HIV testing increased by 630% (AOR: 7.3 (2.6 to 20.7)) and use of sexual health services increased by 220% (AOR: 3.2 (1.62 to 6.27)). We did not find any significant reduction in mental health problems among male adolescents.ConclusionsOur findings suggest that a psychosocial intervention was associated with increased knowledge and uptake of HIV and sexual health services among both male and female migrant adolescents and with reduced mental health problems among female adolescents. Mental health problems varied significantly for male and female adolescents, suggesting that future interventions should be tailored to address their different needs and would benefit from intensive follow-up efforts.

Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review

“…37 Two studies used a pre-post design, without control groups. [38][39][40] Nine studies employed a single follow-up period of either 3 or 6 months; 9,26,28,29,32,33,[37][38][39] six studies variously used two follow-up periods that ranged from 2, 3, 6, 9, 12 and 24 months, 27,30,[34][35][36]40 and one study used three follow-up periods of 6, 12 and 18 months. 31 The median follow-up period was 3 months.…”

“…9,26,32,37 Several studies also measured caregiver mental health or stress, 9,31,39 as well as general health or well-being of adolescents, 29,30,36 and experiencing abuse or violence. 37,38 Eight studies included a measure that focused on self-efficacy, self-concept or self-esteem of adolescents. For example, three studies used the Rosenberg Self-esteem Scale, 34,35,37 while another three used the Tennessee Self-concept Scale.…”

Experiences in implementation and publication of operations research interventions: gaps and a way forward

“…Formative research enables understanding of the nature of the problem and the programme responses to address it [1,13,14] and determination of the priority target population [15,16], as well as assessing their needs and perceptions regarding the problem and the proposed intervention. Formative research also fosters an understanding of how the new intervention will be introduced into existing services [6,17,18], the potential role of various actors in delivering the intervention and additional elements required for the intervention [19].…”

Mental health—a bridge not so far

“…The evidence base for adolescents is even less robust. Emerging reports show the nature of mental health burden experienced by adolescents 6 and forms of effective provision, such as client centred approaches in Ethiopia. 7 This study adds to the evidence baseespecially for adolescents where the data are much more limited.…”