Adaptation of a Mindfulness based intervention to support Adherence to Antiretroviral Therapy among adolescents in Uganda
Abstract
Adolescents represent a growing share of people living with HIV in sub-Saharan Africa (SSA), yet they have lower engagement in care, poor adherence to medication and viral suppression (VS) compared to adults. We postulate that to achieve optimal adherence, interventions that are tailored to the dynamic social and cognitive needs of adolescents as they pass through life-stages need to be culturally adapted and promoted. Mindfulness and acceptance based interventions are slowly gaining traction as appropriate for adolescents.
The study sets out to adapt a mindfulness based psychosocial intervention called: Acceptance and Commitment Therapy (ACT)-Discoverer, Noticer, Advisor-Values Model (DNA-V) to the Ugandan context, and assess acceptability of the adapted intervention among providers (health care practitioners-HCPs) and users (adolescents living with HIV/AIDS-ALWHA). The study will be carried out at two Kampala Capital City Authority health centers (Kisenyi and Kitebi).
The study is designed to serve as a formative phase, preceding the test of effectiveness of the adapted intervention in a future randomized controlled trial. Mixed methods design will be used following a five step formative method for adapting psychotherapy (FMAP-Hwang 2009). Steps include: collaborating with stakeholders to generate information, integrating generated information into the ACT-DNA-V manual, reviewing and revising the initial culturally adapted ACT-DNA-V with stakeholders, assessing acceptability of the culturally adapted treatment among users and providers as well as other implementation related factors and finalizing adaptation by incorporating feedback from acceptability assessment. Identification of domains for adaptation will be guided by the framework for cultural adaptation of psychological interventions (Heim and Kohrt,2019). Thematic and descriptive analysis will be done to assess acceptability. Findings will be used to justify testing effectiveness of the adapted intervention in a future experiment and possibly integration of mindfulness and acceptance into psychosocial support services offered to adolescents living with HIV.