Telephone-based psychosocial counseling for people living with HIV during the coronavirus disease 2019 pandemic: feasibility, acceptability, and impact on the uptake of psychosocial counseling services in Malawi

Dunga, Shalom

Telephone-based psychosocial counseling for people living with HIV during the coronavirus disease 2019 pandemic: feasibility, acceptability, and impact on the uptake of psychosocial counseling services in Malawi

Date

2021-07-13

Authors

Dunga, Shalom

Publisher

Kamuzu University of Health Sciences

Abstract

This will be a mixed-method study, of a convergent parallel design. Quantitatively, cross sectional descriptive and quasi experimental interrupted time series designs will be employed. For qualitative data, a phenomenological approach will be used. Psychosocial counseling (PSC) to people living with HIV (PLHIV) is traditionally provided in person. However, since the emergence of the coronavirus disease of 2019 (COVID 19), long physical in-person encounters, have been discouraged. To ensure that PLHIV continue to receive PSC, telephone-based PSC (T-PSC) was introduced at all Baylor-Tingathe supported health facilities in Malawi. While T-PSC has potential advantages, it is unclear whether T-PSC is acceptable or feasible, particularly in the Malawi context where literacy levels and phone ownership are low. The impact of T-PSC on the uptake of PSC services in Malawi is also unknown. This study seeks to understand whether T-PSC is a feasible and acceptable approach to providing PSC during the COVID 19 pandemic in Malawi and assess its impact on the uptake of PSC services. The main objective is to assess the feasibility, acceptability, cost and incremental cost of T- PSC for PLHIV, and whether T-PSC increases the coverage of PSC services during the COVID 19 pandemic in Malawi. The specific objectives are: Firstly, to assess the feasibility of T- PSC to PLHIV eligible for counseling during the COVID 19 pandemic. Secondly, to assess cost and incremental cost associated with T-PSC compared to in-person counseling, thirdly to assess the acceptability of T-PSC from the point of view of providers who make referrals, psychosocial counselors providing the service, and the PLHIV receiving the service and fourthly, to assess whether T- PSC increases the coverage of PSC services. The study will be conducted in six districts, in Malawi, involving clients from 96 Ministry of Health (MOH) facilities that are supported by Baylor-Tingathe. Study participants will include 1) psychosocial counselors, 2) clients who receive T-PSC and 3) referral providers. Data will be collected from psychosocial counselor daily call logs and weekly reports, for the first and third objectives, and through client exit interviews, and in-depth interviews, for the second objective. Quantitative data will be analyzed in Stata. Means and proportions will be calculated. Likert-scale data to assess the acceptability of T-PSC will be analyzed by calculating the total score for each client, and mean, median, and modal of scores for all clients. 2-sample t-tests, group student ttests, and chi-square tests will be used to measure associations. Cost analysis and time series analysis will be conducted and differences in uptake of PSC before and after the COVID 19 will be tested using a two-sample t-test. Qualitative data will be transcribed and translated to English and analyzed using thematic analysis. The consolidated framework for implementation science (CFIR), will be used to classify and report barriers and facilitators. T-PSC may be a practical, scalable option to not only provide PSC but to expand coverage of the service to patients who live beyond the direct clinic population of the psychosocial counselor, since PSC services by qualified counselors are not widely available in Malawi. Should T-PSC be deemed feasible and acceptable, it will be further explored for effectiveness in bringing desired client outcomes and recommended for scale-up. The findings of this study will be compiled in a comprehensive report that will be submitted for marking to the School of Public Health and Family Medicine (SPHFM) within the Kamuzu University of Health sciences (KUHES). Copies will be submitted to the College of Medicine Research and Ethics Committee (COMREC), the College of Medicine Library, and the Malawi HIV Implementation Science Training (MHIRST) coordinating team. The results will also be shared with the Department of HIV and AIDS (DHA) within the Telephone based psychosocial counseling protocol Version 2.0 dated 18 June 2021 18 | P a g e ministry of health, and will also be submitted for presentation over scientific forums. The manuscript will be submitted for publication in relevant peer-review journals.