Peer-reviewed article
Couples problem-solving therapy for perinatal women living with HIV and male partners in Malawi: a study protocol for a pilot trial of <i>Mphatso</i>.
Conroy AA, Butterfield RM, Mkandawire J, Mulauzi N, Bengtson AM et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study protocol describes a pilot trial of Mphatso, a couples-based intervention combining problem-solving therapy with relationship skills training, designed to reduce depression in pregnant women living with HIV in Malawi. The intervention targets perinatal depression, which interferes with prevention of mother-to-child HIV transmission, and aims to improve maternal nutrition, male partner engagement and PMTCT adherence. The study will randomise 60 pregnant women and their male partners to either five sessions of Mphatso or enhanced usual care, measuring feasibility, acceptability and exploratory health outcomes over six months postpartum.
Key points
- Perinatal depression among women living with HIV in sub-Saharan Africa is understudied yet common and associated with poor engagement in HIV prevention of mother-to-child transmission
- Male partners can provide critical social and economic support during pregnancy but may also contribute to women's stress through intimate partner violence and withdrawal of support
- Few interventions have engaged male partners around women's depression, nutrition and PMTCT engagement
- The pilot trial will assess feasibility and acceptability through attendance rates, satisfaction and retention, with exploratory analyses of effects on depressive symptoms, PMTCT adherence and food insecurity
- The study is registered (NCT06659315) and approved by ethics committees in the US and Malawi
Limitations
This is a study protocol, not results. The document describes the planned study design but provides no data on effectiveness, feasibility outcomes, or participant experiences. The pilot nature with 60 participants limits generalisability to other settings or populations.
Abstract
Introduction Perinatal depression is a common, yet understudied, mental health disorder among women and contributes to poor engagement in prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa. Male partners are positioned to provide critical forms of social and economic support during pregnancy and postpartum, and also may contribute to women's stress, depression and anxiety through intimate partner violence and withholding of social support. Despite the critical role of men in pregnancy outcomes and HIV prevention, few interventions have engaged men around women's depressive symptoms, nutrition and health, and engagement in PMTCT. We will conduct a pilot trial of Mphatso, a couple-based intervention based on problem-solving therapy with couple relationship skills to reduce depressive symptoms in perinatal women, improve food insecurity and prevent HIV transmission to the infant. Methods and analysis We will employ a two-arm pilot randomised controlled trial in the Zomba district of Malawi to assess the feasibility and acceptability of Mphatso (meaning 'gift' or the child) and explore health impacts on depressive symptoms, PMTCT engagement and food insecurity. We will enrol 60 pregnant women in the second or third trimester who are living with HIV and meet criteria for probable depression based on the Edinburgh Postnatal Depression Scale and their male partners. Couples will be randomised to receive either five sessions of Mphatso (problem-management skills plus health education and relationship skills) or enhanced usual care. Feasibility and acceptability outcomes will include session attendance rates, satisfaction levels and retention at 3 months and 6 months postpartum. Exploratory analyses using regression models including time and treatment arm will be conducted to explore effects on the mothers' and fathers' depressive symptoms, adherence to PMTCT (antiretroviral therapy, nevirapine use, HIV testing and exclusive breastfeeding) and food insecurity. Ethics and dissemination The pilot trial has been approved by the University of California, San Francisco (Human Research Protection Program (HRPP); Protocol Number 23-40685), and the study has also been approved by the National Health Sciences Research Committee in Malawi (NHSRC; Protocol Number 24/05/4431). Results will be disseminated to study participants, health officials, policymakers, community leaders and care providers, as well as through presentations at conferences and publications in peer-reviewed journals. Trial registration number NCT06659315.