Transforming Maternal Mental Health through Peer Support: Evidence from the ABCD Thinking Healthy Groups Model Among Young Mothers Living with HIV In Zambia

Background:
Adolescent girls and young women (AGYW) living with HIV face intersecting challenges related to mental health, stigma, and caregiving during pregnancy and early motherhood. Addressing these vulnerabilities requires scalable, contextually grounded interventions that integrate psychosocial and health support. The Ask-Boost-Connect-Discuss (ABCD) Thinking Healthy Groups model is a peer-delivered, mobile-supported intervention designed to improve maternal mental health, strengthen coping, and enhance mother–child outcomes. Implemented within the SHARPS initiative in Kitwe and Lusaka, Zambia, the model leverages trained peer supporters—young people living with HIV—to facilitate structured group sessions that foster safe, supportive environments for learning and mutual support. This study evaluates the effectiveness of the ABCD intervention among pregnant and breastfeeding AGYW.

Methodology:
A pre–post intervention design was used to assess psychosocial and behavioral outcomes among 400 AGYW aged 15–24 years who were pregnant or had children under two years. Participants were recruited through clinic referrals, community outreach, and peer networks across 14 clinic-community sites. The intervention comprised nine structured group sessions delivered by trained peer supporters using the ABCD framework: Ask (identify needs), Boost (build skills), Connect (link to peers and services), and Discuss (facilitate reflection and problem-solving). Groups of 8–12 participants met regularly in community or clinic settings. Standardized measures of depression (PHQ-9), anxiety (GAD-7), perceived stress, social support (MSPSS), self-efficacy, and maternal–child bonding (MIBS) were collected at baseline and post-intervention. Descriptive statistics and paired-samples t-tests were used to assess changes over time.

Results:
Of the 400 participants, 342 (85.5%) completed the full intervention and assessments, demonstrating high retention and feasibility. The mean age was 20.1 years (SD = 2.4), with 62% first-time mothers. Significant improvements were observed across all outcomes. Depression scores decreased from 12.8 (SD = 4.6) to 7.1 (SD = 3.9) (t(341) = 18.72, p < .001), and anxiety scores declined from 11.3 (SD = 4.2) to 6.5 (SD = 3.7) (t(341) = 16.45, p < .001). Perceived stress also reduced significantly (21.6 to 15.2; t(341) = 17.03, p < .001). Protective factors improved substantially: social support increased from 3.2 (SD = 1.1) to 5.1 (SD = 1.0) (t(341) = -19.28, p < .001), and self-efficacy rose from 24.5 (SD = 6.3) to 31.8 (SD = 5.7) (t(341) = -15.67, p < .001). Maternal–child bonding scores improved (4.9 to 2.1; t(341) = 14.56, p < .001), indicating stronger attachment. Effect sizes ranged from moderate to large (d = 0.78–1.21). Participants also reported improved coping, problem-solving, and emotional regulation. Qualitative feedback highlighted the importance of peer relatability, safe spaces, and stigma reduction, with the ABCD components fostering trust, skills-building, social connection, and reflective dialogue.

Conclusion and Implications:
The ABCD model demonstrates strong potential as a scalable, peer-delivered intervention to improve mental health and psychosocial well-being among AGYW living with HIV. Significant pre–post improvements across multiple domains underscore its effectiveness and relevance in low-resource settings. Integrating peer support within clinic-community systems enhances accessibility and acceptability. These findings support expanding peer-led, group-based mental health interventions within HIV care platforms and highlight the value of combining psychosocial support with broader resilience-building strategies.