What we learned from the CHOMA study

We saw the last participants for the CHOMA study in January 2024. Every person involved has contributed to a greater understanding of young women’s mental health and HIV prevention, and we’d like to thank all the CHOMA participants for their contribution, as well as all the stakeholders at the clinics who made this research possible.

Why was the study done?

Up to 5 out of 10 young women in South Africa have mental health challenges like depression and stress. These challenges can affect how young women use PrEP. “The Friendship Bench” is a counselling approach that was developed in Zimbabwe, and previous research has shown that it can improve mental health symptoms. In the CHOMA study, we explored whether “The Friendship Bench” was acceptable to young people and whether it could improve young women’s mental health and PrEP use in South Africa. PrEP is a daily oral pill that is taken to prevent HIV, you can read more about PrEP at myprep.co.za

Who was enrolled in the study?

We enrolled 116 young women in the study, aged 18-25 years old. We enrolled young women in Johannesburg, South Africa, who were taking PrEP and were also experiencing common mental health symptoms at the time of joining the study.

How was the study conducted?

Participants in the study joined one of two groups that were assigned by a computer program at random, like a flip of a coin. Participants in both groups received standard-of-care mental health services which included mental health assessment at each visit and offer of referral for further mental health care. All participants also received counselling on their PrEP use, following a urine test that showed how much PrEP was in the body. PrEP counselling allowed participants to talk to a counsellor about how to overcome any challenges related to taking PrEP.

In addition to standard-of-care mental health services and PrEP counselling, one of the two study groups also received the Friendship Bench counselling. The Friendship Bench is a type of counselling that focuses on problem-solving. Young female counsellors helped participants to identify personal challenges and come up with a plan to address the challenges. Participants in this group were also invited to an optional Career and Financial Planning workshop.

How long were participants in the study?

All participants were in the study for a period of three months. All participants were asked to attend three study visits in the research clinic. The Friendship Bench group were asked to attend two additional visits which could be conducted in the research clinic, or over the phone.

When did the study start and end?

The study started on 31 March 2023 and ended on the 24 January 2024.

Results of the CHOMA study

There were a number of questions that the study wanted to answer, these are listed below with the corresponding outcome.

  1. Was PrEP adherence better or worse in people who participated in the Friendship Bench compared to those that did not?

    At week 4 (the second study visit) the group that received the Friendship Bench had better PrEP adherence (there was a statistically significant difference between the groups). At week 12 (the last study visit), there was no difference between the groups in their PrEP adherence.

  2. Was there a difference in mental health between the group that received the Friendship Bench and the group that did not?

    There was no difference in mental health between the groups, but the study showed that mental health in both groups improved over the course of the study. About 2 out of 5 participants went from moderate mental health symptoms at the first visit, to mild mental health symptoms at the last visit.

  3. Were participant’s mental health symptoms at the first visit related to their PrEP adherence during the study (how well they took PrEP)?

    Participant’s mental health symptoms at the first visit were not related to their PrEP adherence, or how well they took PrEP.

  4. Was the Friendship Bench acceptable to young women in the study?

    Young women reported that the Friendship Bench counselling was acceptable and addressed unmet mental health needs. The screening and referral offered to all participants in the study was reported as helpful. Young women in the study highlighted that is a need for more awareness, screening and referral for mental health symptoms in public health clinics.

Thank you!

Thank you for your engagement in the study and your interest in the study outcomes! If you have any questions, please contact the Wits RHI community engagement team on 076 840 1106.

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