Skip to main content

25 January 2024

Friendship Bench 'grandmothers' could help control HIV

Friendship Bench therapy delivered by community ‘grandmothers’ could empower people living with HIV to take their medication, according to new research by King's College London and London School of Hygiene and Tropical Medicine (LSHTM).

Grandmother conducting a problem solving therapy session with a young female client on the Friendship Bench  at a primary care clinic in Harare, Zimbabwe

People living with HIV alongside common mental health disorders may be three times more likely to maintain a low level of virus through medication if supported with therapy through the Friendship Bench project, according to new study results published in PLOS Global Public Health.

The study, run in Zimbabwe, is the first of its kind to assess whether community-based therapy through the Friendship Bench project could improve outcomes for those living with long-term illness alongside a mental health disorder.

The Friendship Bench initiative, founded by Professor Dixon Chibanda at LSHTM, uses a community-based approach to provide therapy to people living with mental health disorders. Wooden park benches are placed in discreet areas near to health clinics and each attendee receives up to six one-to-one counselling sessions. The sessions are delivered by older community volunteers, known as ‘grandmothers’, who do not have prior medical knowledge but receive training in problem-solving therapy through the initiative.

For people living with HIV, taking antiretroviral therapy (ART) as prescribed can decrease and maintain a lower level of virus within the body. Sustaining a low viral load is a key goal in HIV care, as it can halt progression to AIDS, enable near-normal life expectancy and decrease the risk of onwards transmission to sexual partners, including that of drug-resistant strains.

Among the most common co-morbidities recorded for people living with HIV are mental health disorders such as depression or anxiety. Previous research has shown that patients living with both conditions may be less likely to adhere to ART.

The study led by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, LSHTM, and the University of Zimbabwe, recruited 700 participants aged 18 and over across eight HIV care clinics in Harare. Patients at six of the clinics received therapy through the Friendship Bench programme, while those at the remaining two clinics received usual care. Blood tests to measure viral load and mental health assessments were taken at the start of the study and followed-up after six months of treatment.

Of the 499 patients who already had a suppressed level of virus at the start of the study, those who received therapy through the Friendship Bench were three times less likely for their viral load to increase above the clinical threshold for suppression, which would prevent sexual transmission of the virus to a HIV-negative partner, compared with those who received usual care (2.9% vs 9.3%). Out of all participants in the study, those who attended the Friendship Bench clinics were also six times less likely to screen for a common mental health disorder at the end of the study (-36.5% vs -6.7%), emphasising the importance of incorporating mental health support into HIV care.

The team are now looking to replicate these findings with a larger cohort and follow patients over a longer period of time. Studies to assess whether the project can support outcomes for people living with common health disorders alongside other chronic illnesses, such as diabetes or hypertension, are ongoing.

Living with HIV is very challenging and can have a potentially devastating impact on a person’s mental wellbeing. Our study establishes that the simple act of receiving basic problem-solving therapy from a lay counsellor in a community setting can positively influence viral suppression and low mood. This benefit was most pronounced for people with depression whose adherence to HIV medication was already good. For people with depression and poor adherence to HIV medication, the Friendship Bench was able to help with low mood but could not get them back on track with adherence and viral suppression. It's vital now that we follow up this research to establish how to improve counselling to optimise HIV disease control. This is what our new trial is testing.

Professor Melanie Abas, joint first author and Professor of Global Mental Health Health at King’s IoPPN

Dixon Chibanda, senior author and Professor of Psychiatry and Global Mental Health at LSHTM, said:

“The world is in the grips of a mental-health crisis. People living with common mental disorders, including those who also need support to manage a long-term condition, are desperately seeking help but don’t know where to turn.

“In an ideal situation, every patient needing psychiatric care would have access to one-on-one therapy with a trained doctor. Unfortunately, even wealthier health systems lack the capacity to offer such services as widely as is needed. The Friendship Bench offers an opportunity to fill this void and to reach patients within the heart of their own communities.”

The Friendship Bench programme has been running for over 10 years in Zimbabwe and has been shown to significantly improve the symptoms of patients with common mental health disorders. It has now been successfully scaled up to all 10 provinces, covering a total population of approximately 16 million. In 2023, over 2000 community health workers helped deliver therapy for over 300,000 people living across the country.

Since its inception, Friendship Benches have also been replicated in other parts of the world including New York, Washington DC, Vietnam and Jordan thanks to funders including the philanthropist MacKenzie Scott and the Mulago Foundation. Professor Chibanda, Professor Abas, and team are also exploring a pilot Friendship Bench in London and testing an enhanced form of the Friendship Bench called TENDAI in people with depression and poorly controlled HIV.

'Effect of a brief psychological intervention for common mental disorders on HIV viral suppression: A non-randomised controlled study of the Friendship Bench in Zimbabwe' (Simms V, Abas MA, Müller M, Munetsi E, Dzapasi L, Weiss HA and Chibanda D) was published in PLOS Global Public Health (DOI: 10.1371/journal.pgph.0001492).

For more information, please contact the IoPPN Press Office.

In this story

Melanie Amna Abas

Professor of Global Mental Health