Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV
Abstract Background Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolle...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Global Health Research and Policy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41256-021-00224-0 |
| _version_ | 1818585799537459200 |
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| author | Katherine G. Merrill Jonathan K. Mwansa Sam Miti Virginia M. Burke Elizabeth A. Abrams Christiana Frimpong Michele R. Decker Jacquelyn C. Campbell Julie A. Denison |
| author_facet | Katherine G. Merrill Jonathan K. Mwansa Sam Miti Virginia M. Burke Elizabeth A. Abrams Christiana Frimpong Michele R. Decker Jacquelyn C. Campbell Julie A. Denison |
| author_sort | Katherine G. Merrill |
| collection | DOAJ |
| description | Abstract Background Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolled 276 youth living with HIV (ages 15–24 years) in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola, Zambia. Methods Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors (YPM) were referred to designated healthcare providers (HCP). We explored experiences with the safety protocol using: a) monitoring data of referrals, and b) in-depth interviews with youth (n = 82), HCP (n = 10), YPM (n = 8), and staff (n = 6). Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed. Results Nearly half of youth enrolled (48% of females, 41% of males) were referred to a HCP at least once. The first referral was most often for sexual violence (35%) and/or suicidal ideation/depression (29%). All referred youth aged 15–17 years and over 80% of referred youth aged 18 + agreed to see a HCP. HCP referred 15% for additional services outside the clinic. Twenty-nine youth, all HCP, all YPM, and all staff interviewed discussed the safety protocol. Most youth felt “encouraged,” “helped,” “unburdened,” and “relieved” by their meetings with HCP; some expressed concerns about meeting with HCP. The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support. HCP, YPM, and study staff raised implementation challenges, including youth choosing not to open up to HCP, time and resource constraints, deficiencies in HCP training, and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health. Conclusions Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike. Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems. Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV. |
| first_indexed | 2024-12-16T08:42:49Z |
| format | Article |
| id | doaj.art-260542ade7cb46d0b288e298efe6cf30 |
| institution | Directory Open Access Journal |
| issn | 2397-0642 |
| language | English |
| last_indexed | 2024-12-16T08:42:49Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Global Health Research and Policy |
| spelling | doaj.art-260542ade7cb46d0b288e298efe6cf302022-12-21T22:37:40ZengBMCGlobal Health Research and Policy2397-06422021-10-016111010.1186/s41256-021-00224-0Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIVKatherine G. Merrill0Jonathan K. Mwansa1Sam Miti2Virginia M. Burke3Elizabeth A. Abrams4Christiana Frimpong5Michele R. Decker6Jacquelyn C. Campbell7Julie A. Denison8Department of International Health, Johns Hopkins Bloomberg School of Public HealthArthur Davison Children’s HospitalArthur Davison Children’s HospitalDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthArthur Davison Children’s HospitalDepartment of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public HealthDepartment of Community-Public Health, Johns Hopkins School of NursingDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthAbstract Background Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolled 276 youth living with HIV (ages 15–24 years) in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola, Zambia. Methods Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors (YPM) were referred to designated healthcare providers (HCP). We explored experiences with the safety protocol using: a) monitoring data of referrals, and b) in-depth interviews with youth (n = 82), HCP (n = 10), YPM (n = 8), and staff (n = 6). Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed. Results Nearly half of youth enrolled (48% of females, 41% of males) were referred to a HCP at least once. The first referral was most often for sexual violence (35%) and/or suicidal ideation/depression (29%). All referred youth aged 15–17 years and over 80% of referred youth aged 18 + agreed to see a HCP. HCP referred 15% for additional services outside the clinic. Twenty-nine youth, all HCP, all YPM, and all staff interviewed discussed the safety protocol. Most youth felt “encouraged,” “helped,” “unburdened,” and “relieved” by their meetings with HCP; some expressed concerns about meeting with HCP. The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support. HCP, YPM, and study staff raised implementation challenges, including youth choosing not to open up to HCP, time and resource constraints, deficiencies in HCP training, and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health. Conclusions Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike. Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems. Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV.https://doi.org/10.1186/s41256-021-00224-0Safety protocolReferralViolenceMental healthHIVYouth |
| spellingShingle | Katherine G. Merrill Jonathan K. Mwansa Sam Miti Virginia M. Burke Elizabeth A. Abrams Christiana Frimpong Michele R. Decker Jacquelyn C. Campbell Julie A. Denison Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV Global Health Research and Policy Safety protocol Referral Violence Mental health HIV Youth |
| title | Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV |
| title_full | Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV |
| title_fullStr | Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV |
| title_full_unstemmed | Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV |
| title_short | Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV |
| title_sort | experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with hiv |
| topic | Safety protocol Referral Violence Mental health HIV Youth |
| url | https://doi.org/10.1186/s41256-021-00224-0 |
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