An Adapted Friendship Bench for adolescents living with and at risk for HIV in Botswana: a mental health needs assessment and feasibility study

We will assess depression, anxiety, and substance use in adolescents at risk for a living with HIV. We will also assess the feasibility, acceptability and safety of a previously adapted version of the Friendship Bench (Bench). The Friendship Bench is a youth lay counsellor technique modelled after a previous study conducted in Zimbabwe. The Friendship Bench is a physical space and a methodology. , It is a method which is executed in a private physical space that is not bound to one specific location. One can have a friendship bench in a shady spot under a tree as the requirements are a lay counsellor, a client, and privacy. This study aims to provide a needs assessment for the Botswana youth living with HIV or at high risk for HIV acquisition by screening. We also aim to evaluate whether a previously adapted version of the Bench will be acceptable, feasible, and safe for a feasibility cohort of target youth. We will then convene a stakeholder group that will, with feedback from this feasibility cohort of participants, further adapt the intervention in preparation for further studies. During the first phase of this sub-study, we seek a greater understanding of rates of common mental illness for both youth living with HIV and youth at risk for HIV. We aim for an evaluation and data collection that will inform our understanding of youth living with HIV from all over Botswana that attend a referral clinic. Second, with a sample of youth at risk for HIV (not HIV+) in a setting outside of the capital city, we will perform surveys to gain greater understanding of mental health and substance use risk factors in community youth at risk for HIV in this setting where HIV incidence is very high during adolescence and young adulthood. In addition to its greater implications for the communities from which these data will come, the data also serves to inform other elements of our project. This aim will help us to establish a scope of the need for intervention and allows us to better plan for a pilot study. Our second and third phases are implementation and adaptation phases. Aim 2 is an accessibility, feasibility and safety aim. We will evaluate the feasibility of future larger scale studies by exposing a small number of youth living with HIV to the 6 session Botswana Adapted Friendship Bench for youth. Wee will collect data on follow-up, and record what was needed in terms of materials, space, support for the near peer youth lay counsellors (NPYLC), and communication needed to execute the intervention and maintain participant engagement. Lastly, with this aim we will assess acceptability using surveys and semi-structured interviews. Aim 3 focuses on dynamic adaptation of the intervention. The adapted Bench for youth in Botswana that will be evaluated in Aim 2, is an adaptation of the original Friendship Bench. That adaptation occurred in another related study that focused on the stakeholder-informed theoretical needs and core-components of such an intervention in the Botswana youth context. Aim 3 will use the feasibility and acceptability data from Aim 2 to adjust the adapted Bench in preparation for further studies and implementation in a variety of settings from clinical to community.