Phone-based psychosocial counseling for people living with HIV: Feasibility, acceptability and impact on uptake of psychosocial counseling services in Malawi

• Published in: Global mental health Vol. 11; p. e3
• Main Authors: Cox, Carrie M., Masiano, Steven, Mazenga, Alick, Stark, Madeline, Udedi, Michael, Simon, Katherine R., Ahmed, Saeed, Nyasulu, Phoebe, Kim, Maria H.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 2024
• Subjects: Africa; HIV; Interventions; mental health; tele-health; tele-health; HIV; mental health; Africa
• ISSN: 2054-4251; 2054-4251
• DOI: 10.1017/gmh.2023.84

People living with HIV experience psychosocial needs that often are not addressed. We designed an innovative low-resource model of phone-based psychosocial counseling (P-PSC). We describe cohort characteristics, acceptability, feasibility and utilization of P-PSC at health facilities supported by Baylor Foundation Malawi. Staff were virtually oriented at 120 sites concurrently. From facility-based phones, people with new HIV diagnosis, high viral load, treatment interruption or mental health concerns were referred without identifiable personal information to 13 psychosocial counselors via a WhatsApp group. Routine program data were retrospectively analyzed using univariate approaches and regressions with interrupted time series analyses. Clients utilizing P-PSC were 63% female, 25% youth (10–24 y) and 9% children (<10 y). They were referred from all 120 supported health facilities. Main referral reasons included new HIV diagnosis (32%), ART adherence support (32%) and treatment interruption (21%). Counseling was completed for 99% of referrals. Counseling sessions per month per psychosocial counselor increased from 77 before P-PSC to 216 in month 1 (95% CI = 82, 350, p = 0.003). Total encounters increased significantly to 31,642 in year 1 from ~6,000 during the 12 prior months, an over fivefold increase. P-PSC implementation at 120 remote facilities was acceptable and feasible with immediate, increased utilization despite few psychosocial counselors in Malawi.