A pilot study to evaluate the feasibility and acceptability of a mobile phone counselling intervention for perinatal women living with HIV and depression in India.

Abstract

Pregnant and postpartum women living with Human Immunodeficiency Virus (HIV) are at high risk for perinatal depression, which can significantly undermine HIV care engagement and treatment outcomes. Despite this, depression often remains unidentified and untreated. This pilot study evaluated the feasibility, fidelity, acceptability and preliminary effects of a mobile phone counselling intervention among perinatal women living with HIV and depression in India. Forty women in their third trimester (≥28 weeks of gestation) and screening positive for depressive symptoms (Edinburgh Postnatal Depression Scale ≥13) were recruited from three government-run treatment centres in Delhi. Participants were randomized to: (a) the intervention condition, 'BEST-ma-CARE' mobile phone counselling, or (b) an attention control condition, time- and phone-matched perinatal wellness counselling. All counselling was delivered via basic mobile phones. Data were collected at baseline and follow-up at 36-40 weeks pregnancy, within 7 days of delivery and at 6 and 12 weeks postpartum. Overall, 82% of the participants completed the study, with higher retention in the intervention arm (90%). Engagement was also higher in the intervention group with 78% of antenatal and 95% of postnatal calls attended, compared to 70% and 80% in the control group. The intervention was highly acceptable; 76% reported it 'helped them a lot', compared to 69% in the control group. All participants (100%) appreciated scheduled counsellor calls. Both groups showed reductions in depressive symptoms and perceived illness severity, while internalized stigma increased only in the control group. Improvements in antiretroviral adherence, viral load and CD4 counts were stronger in the intervention group. Results indicate that integration of mobile phone counselling into maternal HIV care shows promise.