Agnes Karingo Karume, MBChB, MBA, MPH
Nominated From: University of Washington
Research Site: Kenyatta National Hospital
Research Area: Perinatal Mental Health
Primary Mentor: Dr. Anjuli Wagner
Research Project
Application of FRAME-IS in the Adaptation and Optimization of Integrated Perinatal Mental Health, and Use of CFIR to Identify Barriers and Facilitators in Integrating Perinatal Mental Healthcare within PMTCT and MCH Clinics in Kenya
Approximately 10-20% of pregnant and postpartum women experience depression and anxiety during pregnancy or up to 1 year postpartum. There is an elevated burden in low- and middle-income countries (LMICs). In addition to causing significant disability among perinatal women, depression and anxiety is associated with risks to the infant, including elevated risk of preterm birth, low birth weight, intra uterine growth retardation, pregnancy loss, stillbirth and among women living with HIV(WHIV) the risk of vertical transmission of HIV to their unborn child. However, most of these cases go undetected and untreated since under 30% of those requiring mental health services have access to them. Integrated perinatal mental health that encompasses universal mental health screening, provision of problem management plus(PM+) psychotherapy by non- specialists(such as peer mentors also known as mentor mothers and HIV Testing Counselors) and in facility telepsychiatry linkage for women with severe symptoms has the potential to enhance access to care for women including WLHIV with perinatal depression and anxiety. We will first use the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to integrating Perinatal Mental Healthcare within Prevention of Mother-to-Child Transmission (PMTCT) and Maternal-Child Health (MCH) Clinics. We will then adapt and optimize the integration into PMTCT and MCH, universal mental health screening, problem management plus and telepsychiatry for peri-natal women including WLHIV with depression, anxiety and document the adaptation and optimization process using FRAME-IS (The expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions).
Research Significance
This research will address gaps in our understanding of the barriers and facilitators to integrating perinatal mental health into maternal and child health clinics. It will provide valuable insights into implementation strategies for scale-up, potentially improving mental health outcomes for all women, including those living with HIV who experience perinatal depression and anxiety.
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