Lessons From Implementing Ask-Boost-Connect-Discuss, a Peer-Delivered Psychosocial Intervention for Young Mothers Living With HIV in Malawi, Tanzania, Uganda, and Zambia

Christina Laurenzi; Don Operario; Chipo Mutambo; Eugene Mupakile; Blessings Banda; Fileuka Ngakongwa; Richard Kilonzo; Chuma Busakhwe; Agnes Ronan; Elona Toska

doi:10.9745/GHSP-D-23-00077

Figures & Tables

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TABLE 1.

Overview of Components and Sessions in the Ask-Boost-Connect-Discuss Program to Support Young Mothers Living With HIV

Program Domain	Activity	Description
Ask	Pre-enrollment check-in	Peer supporters used mood charts or verbal prompts to check with participants before they attended group sessions
Ask	Session 0	Welcome session for new participants Physical and emotional health; consent; confidentiality; expectations of participation
Boost	Key components	Structured curriculum with specific content per session; goal-setting worksheets and mood charts linked to each session for participants to take home and use as works for them
	Session 1	Health-seeking behavior Theme: “There are some things I have control over.”
	Session 2	Anxiety and uncertainty in pregnancy and motherhood Theme: “Nobody has all the answers.”
	Session 3	Support networking Theme: “Support can come from different places.”
	Session 4	Self-care during pregnancy and motherhood Theme: “Motherhood is a big change, but I also need to focus on my own well-being.”
	Session 5	Addressing concerns around child growth and development Theme: “Each child grows differently.”
	Session 6	Combating stigma and external judgment Theme: “What others think doesn't matter, if I have love for myself and my child.”
	Session 7	Making time to adopt healthy practices Theme: “Focusing on healthy behaviors takes little effort and is very valuable.”
	Session 8	Future orientation and goal-setting Theme: “Even though I have HIV, I can still embrace a bright future for myself, and my baby.”
Connect	Referral mechanisms for at-risk participants	Set up on a case-by-case basis with clinic-based mentors
Connect	Additional resources for peer supporters	In-app training manual and 1–2 page tip sheets on issues including PMTCT of HIV, mental health psychoeducation, HIV testing, and communication skills
Discuss	Supervision component	Routine supervision meetings by PATA technical advisors; WhatsApp groups formed to facilitate easy communication among peer supporters in each focal country

Abbreviations: PATA, Paediatric-Adolescent Treatment Africa; PMTCT, prevention of mother-to-child transmission.

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TABLE 2.

Description of Data Sources for the Feasibility Assessment of the Ask-Boost-Connect-Discuss Program to Support Young Mothers Living With HIV

Data Source	Sample Details	Country (Language)	Time Frame	Additional Notes on Data Source
FGDs	Peer supporters (n=5)	Tanzania (Swahili)	September 2019	Translated and transcribed verbatim by in-country technical advisor
	Peer supporters (n=3, 1 per participating facility)	Uganda (English)	September 2019	Summarized in notes format
	FGD1: Peer supporters (n=3), participants (n=2), clinic-based mentors (n=1) FGD2: Peer supporters (n=3), participants (n=1), clinic-based mentors (n=2) i	Zambia (English)	November 2021	Conducted in person, summarized in notes format
Clinic mentor written feedback	Clinic-based mentors (n=3, 1 per participating facility)	Uganda (English)	September 2019	Summarized in notes format
Technical advisor written final reports	Technical advisors (n=4, 1 per country)	Malawi, Tanzania, Uganda, Zambia (English)	December 2019	Received as email correspondence
Technical advisor debriefing session	Technical advisors (n=4, 1 per country)	Malawi, Tanzania, Uganda, Zambia (English)	January 2020	Meeting minutes, from virtual session
Individual semistructured interviews	Peer supporters (n=4)	Malawi, Uganda, Zambia (English)	January 2021	Conducted remotely, audio-recorded, transcribed verbatim

Abbreviation: FGD, focus group discussion.

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TABLE 3.

Overview of Themes in the Feasibility Assessment of the Ask-Boost-Connect-Discuss Program to Support Young Mothers Living With HIV

Theme	Bowen's Framing of This Domain²⁵	Guiding Question in the Context of This Article	Core Theme	Subtheme: Additional Adaptations
Exploring acceptability	To what extent is a new idea, program, process, or measure judged as suitable, satisfying, or attractive to program deliverers? To program recipients?	Is it acceptable to deliver psychosocial content to young mothers and for peers to be the implementers?	Acceptability centered around peer engagement and positive participant feedback	Responding to participant preferences and needs on structure and format
Exploring practicality	To what extent can an idea, program, process, or measure be carried out with intended participants using existing means, resources, and circumstances and without outside intervention?	Is it practical to task-shift to trained peers to deliver a semistructured program to a high standard?	Training, technical competence, and skills development	Responding to emergent needs identified in sessions
Exploring integration	To what extent can a new idea, program, process, or measure be integrated within an existing system?	Can a peer-delivered psychosocial program be effectively embedded within the health system and respond to extant needs innovatively?	Purposeful planning to smooth implementation Challenges to implementation	Adapting to “dis”-integration: pivoting to meet clients' needs in restricted circumstances