Mixed methods study of SKILLZ Plus with integrated depression screening and group therapy among youth living with HIV in Zambia

DETAILED SUMMARY

Importance
Youth living with HIV (YLHIV) face elevated risks of depression and poor mental health outcomes, but access to mental health support within HIV programming remains limited. In Zambia, there is a significant gap in addressing both HIV care and mental health needs for adolescents. The Strong Bodies, Strong Minds project sought to integrate depression screening and group therapy into the existing SKILLZ Plus program for YLHIV.

Objective
To assess the feasibility, acceptability, effectiveness, and scalability of the integrated SKILLZ Plus and Interpersonal Therapy for Groups (IPT-G) model among YLHIV participants and Grassroot Soccer Coaches and staff in Lusaka and Chipata, Zambia, across 2021 and 2022.

Study details

• Study design: Mixed methods study; no control group
• Data collection tools: In-depth interviews with 7 SKILLZ Plus Coaches (5 in Lusaka, 2 in Chipata); in-depth interviews with 3 GRS Zambia staff and 1 SMZ staff member; PHQ-9 screening data and IPT-G therapy outcome data (2021 and 2022)
• Participants: YLHIV ages 9–30 years (average 17–18 years), mixed gender; SKILLZ Plus Coaches; GRS Zambia and StrongMinds Zambia (SMZ) staff
• Implementation setting: Health facilities and community settings in Lusaka and Chipata, Zambia (urban)
• Study period: 2021 to 2023

Intervention

• SKILLZ Plus: Integrated model combining the SKILLZ Plus program for YLHIV with IPT-G depression therapy groups. Participants were screened for depression using the PHQ-9 tool; those scoring 10 or higher (or reporting suicidal ideation) were referred to IPT-G therapy groups facilitated by trained SKILLZ Plus Coaches.

Results

• Results demonstrate that in 2021, 2,232 YLHIV participants were administered the initial PHQ-9 screening, of whom 28.9% (n=647) screened as depressed and eligible for therapy. Of these, approximately 42% (n=271) were enrolled in therapy. The average PHQ-9 score at pre-group was 14.6, indicating moderate depression. Of those enrolled, 81% (n=219) were female and the average age was 18 years.
• Results demonstrate that in 2021, among participants completing therapy (n=161), the average PHQ-9 score decreased by 11.77 points.
• More than 96% of participants who completed therapy showed a clinically significant decrease (5+ points) in PHQ-9 score.
• Results demonstrate that in 2022, 725 YLHIV participants were enrolled in IPT-G following pre-group screening. The average PHQ-9 score at pre-group was 14.76. Retention was high, with 79% attending at least 5 sessions. Among participants with complete data (n=530), the average PHQ-9 score change was 11.86 points, and 88.3% were depression-free at termination, compared to 52% in 2021.

Conclusions and implications

• The integrated SKILLZ Plus and IPT-G model demonstrated strong effectiveness, acceptability, and preliminary feasibility in the SBSM project, with clinically significant reductions in depression symptoms across two years and strong retention, even when facilitated by SKILLZ Plus Coaches rather than professional mental health staff.