Enhancing a peer supporter intervention for young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia: Adaptation and co-development of a psychosocial component

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Paediatric-Adolescent Treatment Africa (PATA) is a non-governmental organisation that has worked with over 400 health facilities, and implemented and evaluated 10 incubation projects in sub-Saharan African countries. PATA has been a long-time advocate of peer support programming, and has supported multiple networks of peer supporters over the past decade (Mark et al., 2019). PATA’s peer supporters are based at health facilities and communities, and deliver adherence and psychosocial support through monthly peer support groups, and linkage to other services. Peer supporters are recruited based on a defined set of criteria; adolescents and young people ages 18–24 openly living with HIV and successfully adhering to treatment and care are eligible. These individuals are trained to focus on HIV treatment literacy and adherence education, sexual and reproductive health and rights, disclosure, and general psychosocial support to clients. Peer supporters also learn skills related to group facilitation, communication, leadership, advocacy, and record-keeping. They become equipped to support bi-directional referrals between facility-based teams and community-based services, identify urgent cases of treatment failure and psychosocial need, and manage ethical dilemmas. Peer supporters are age-matched to their target client population, typically a few years older but still relatable as near-peers. They typically connect to clients through routine clinic visits, and sometimes work as a team if based at the same facility. Most peer supporters actively engage with approximately 20–40 adolescents at any given time. Ongoing in-service support through mentorships, regular supervision and performance review are also provided to peer supporters by their facility-based supervisors and PATA’s country-based technical advisors; they can similarly access job aides, supportive materials and regular feedback from health workers and clients through PATA’s centralised support (learning platform, events, and technical advisors). PATA’s peer supporters, importantly, are integrated as fundamental members of the facility health teams, helping to support the take-up of adolescent-friendly health services and allowing for meaningful engagement between peer supporters and other health workers.

Table 1. Data sources across each phase.

Data source	Phase 1: Formative research	Phase 2: Content adaptation and development	Phase 3: Consultation, refinement and modification
Consultation session notes	X	X	X
Peer supporter initial feedback	X
Expert consultations	X		X
Scoping review of literature	X	X
Questionnaires from technical advisors	X	X
Notes from informal interviews with young mothers	X	X
Source intervention manual to be adapted	X	X
Additional debriefing meeting notes			X

Figure 1. Flow of intervention adaptation and co-development.

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Session structure: Attendance Recap of previous session’s theme and topic Introduction of the session’s theme through exploring negative/unhelpful thoughts linked to the theme, and probing related feelings and behaviours as a group Identifying positive thoughts to replace this negative thought Group discussion and individual selection of helpful/positive thoughts to try Group activity to put discussion into practice Summary of discussion

Mark, D., Hrapcak, S., Ameyan, W., Lovich, R., Ronan, A., Schmitz, K., & Hatane, L. (2019). Peer support for adolescents and young people living with HIV in sub-Saharan Africa: Emerging insights and a methodological agenda. In Current HIV/AIDS Reports. https://doi.org/10.1007/s11904-019-00470-5.

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