Piloting a Near-Peer Lay Counselor Based Problem Solving Therapy Intervention for Youth With and Without HIV in Botswana: An Adaptation of the Friendship Bench

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PURPOSE: The adolescent mental health treatment gap is a significant public health challenge, especially in low-resource settings where services are often adult-oriented. The Safe Haven intervention, adapted from Zimbabwe's Friendship Bench, addresses this gap by leveraging near-peer youth lay counselors trained in Problem-Solving Therapy. This study evaluates the feasibility and outcomes of Safe Haven across three sites in Botswana. METHODS: Participants aged 12-25 years (N = 115) were recruited from clinical and community sites. Pre-intervention and post intervention assessments using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Shona Symptom Questionnaire measured depression, anxiety, and common mental disorder symptoms. Pre/post differences in scores were statistically tested using Wilcoxon signed-rank tests. RESULTS: Significant reductions were observed in all mental health outcomes. Over four to six sessions (4-16 weeks), median Patient Health Questionnaire-9 scores decreased from 6 (interquartile range [IQR] 4-11) to 1 (IQR 0-3) (p < .001), with 78% showing improvement, and moderate depression symptoms reduced from 29% to 3%. Generalized Anxiety Disorder-7 scores decreased from 9 (IQR 7-12) to 2 (IQR 0-7), with 86% improving, and moderate or severe anxiety symptoms declined from 47% to 9%. Shona Symptom Questionnaire scores decreased from 10 (IQR 7-14) to 1 (IQR 0-4) (p < .001), with 93% improving. DISCUSSION: Safe Haven demonstrates potential in addressing Botswana's youth mental health needs, including underserved groups such as younger adolescents and those living with HIV. Although limitations include the prepost design and small sample size, findings support further scaling and controlled evaluations to optimize impact across diverse settings and populations.

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