MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt)

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Adolescent Health & Development

DoBAT

Digital delivery of Behavioural Activation to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAT Study) 

  • PI(s): Kathleen Kahn, Alan Stein
  • Project Manager: Bianca Moffett
  • Funder: The South African Medical Research Council (SA) and the UK Medical Research Council (UK)
  • Collaborating Institutions: Oxford University, Cambridge University, and Exeter University (UK); University of Cape Town, and University of Limpopo (SA); University of California Los Angeles (USA) 

Depression is the leading cause of disability worldwide, and its incidence peaks during adolescence. In South Africa around 20% of adolescents struggle with symptoms of depression. Left untreated, depression interferes with young people’s ability to fulfil their potential and is a major risk factor for suicide. Effective psychological treatments to address depression exist, but the reality is that most young people do not have access to them. 

The DoBAt study aimed to develop and evaluate a digital intervention to address depression amongst adolescents in low- and middle-income countries using an evidence-based psychological therapy called Behavioural Activation. 

During phase 1 (March 2019-Sept 2021), we developed the ‘Kuamsha app’ through an iterative process of co-design with over 160 adolescents and other stakeholders. The Kumasha app is an interactive narrative game consisting of six tailored modules (sessions) containing Behavioural Activation’s core principles. The app is also supported by weekly phone calls from trained Peer Mentors who help adolescents integrate the lessons learnt through the app into their daily lives. 

During phase 2 (Sept 2021-March 2023), we conducted a pilot randomised controlled trial (n=200) to assess the feasibility, acceptability, and initial efficacy of digitally delivered Behavioural Activation (the Kuamsha programme) in addressing depression amongst adolescents in rural South Africa. We also piloted novel locally-adapted measures of mental health, social cognition, executive functioning, and key socio-economic outcomes.

Ntshembo Trial

Ntshembo (Hope) Trial - Intervention to optimise adolescent BMI pre-conception to address the double burden of malnutrition: an RCT in rural and urban South Africa 

  • PI(s): Kathleen Kahn, Shane Norris
  • Project Managers: Eva Mathatha, Simone Crouch
  • Funder: Joint Global Health Trials Development Grant
  • Collaborating Institutions: Developmental Pathways for Health Research Unit (DPHRU), and the University of Limpopo (SA) 

Obesity is a rapidly growing problem in rural as well as urban adolescent girls in South Africa. This, together with persistent underweight, is fuelling increasing type 2 diabetes in young women, and putting their future offspring at similar risk. Improving adolescent nutritional status and developing pre-pregnancy interventions that promote nutrition and healthy behaviours in poor communities where childbearing tends to start at a younger age, may contribute to combating this trend.

The Ntshembo trial enrols both underweight and overweight girls aged 14-19 years from rural Agincourt and urban Soweto. An 18 month intervention is delivered by specially trained community health workers (CHWs) who: (i) promote healthy behaviours and improve diets; (ii) provide a multi-micronutrient supplement to combat deficiencies, particularly anaemia; (iii) provide the primary caregiver with a conditional cash transfer to encourage and enable better household dietary diversity within the context of food insecurity, and (iv) support adolescents who become pregnant to use antenatal care services earlier in their pregnancies and more frequently. CHWs are trained in 'Healthy Conversation Skills' that support behaviour change, developed and tested for use with socioeconomically disadvantaged women.

After baseline assessment and randomisation, trial participants will be reassessed after 18 months follow-up. If a participant becomes pregnant in this period, the reassessment will be carried out early in her pregnancy and additional measures and antenatal clinic data will be collected during the pregnancy and from the infant at birth. The trial includes process and economic evaluations.

Implementation Science to Improve Delivery of PrEP
  • PI(s): Sheri Lippman, Kathleen Kahn, Hannah Leslie 
  • Project Manager: Denny Mabetha
  • Funder: NIMH, NIH (USA)
  • Collaborating Institutions: UCSF (USA)

In early 2021 the US NIH awarded a small grant to  Sheri Lippman at the University of California, San Francisco, and Kathleen Kahn of MRC/Wits to undertake research applying Implementation Science Methods to Improve PrEP Services for people at risk for HIV.  The project aims to fill the critical gap in the delivery of equitable, integrated, and quality HIV care including PrEP for adolescents and young women at risk of HIV infection in the Bushbuckridge area.  The project includes 3 phases: 

  • Exploring the local context of PrEP delivery at the intersection of the patient, clinical setting, and health system.
  • Identifying and selecting specific strategies that are responsive to the local context and feasible for facilities to implement in order to improve PrEP delivery in primary care clinics.
  • Monitoring the implementation of selected strategies in order to determine what works to improve PrEP delivery and to make recommendations for scale-up across the area. 
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