Title: Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent
mothers living with human immunodeficiency virus (HIV): A qualitative analysis
Version: 3 Date: 08 Jun 2021
Reviewer's report:
Thank you for the opportunity to review this important manuscript that addresses a critical need
of task shifting to employ Community Health Workers in the context of limited mental health
personnel in Nairobi, Kenya. I organize my comments under broad categories for a logical
review.
1. Importance of submission: What are the manuscript's strengths? Is it significant? Does it
contain new and unique information?
The manuscript addresses a significant issue of use addressing postpartum depression among
young women in Kenya using Group Interpersonal Psychotherapy (IPT-G) provided by CHWs
in two primary care settings in Nairobi Kenya. Authors posit that they aim to assess qualitatively
the acceptability and feasibility of IPT-G for postpartum adolescents living with HIV being
delivered by CHWs within routine clinical settings in Nairobi, Kenya as stated on page 7 on the
manuscript.  The aim could benefit from rewriting for clarity so that the subject of the sentence
is clear. This aim is slightly different from what is stated on the abstract where authors state
“In our study, we seek to assess the acceptability and feasibility of IPT-G delivered by CHWs
among depressed postpartum adolescents (PPAs) living with HIV. The aim more clearly written
in the abstract. Authors should consider using the aim as written in the abstract. Also consider
spell out acronyms when first mentioned.
The background section is presented well and logically. One would expect that as presented on
the background section, the manuscript would subsequently be focused on the CHWs role in
implementing IPT-G.
Topic is important one; training CHWs to deliver mental health services in primary care setting
in the context of limited psychiatric practitioners is important.  Training of the CHW for the
interventions is well described.
2. Theoretical evaluation: Is the manuscript logical? Is the theory parsimonious? Complete?
Useful?
Some sections of the manuscript are well written and logical.  While the intervention is described,
there is no description of theoretical framework that underpins the study. A theory or theoretical
framework would be beneficial to ground the study. While the authors state that qualitative
approach was used, it appears from the methods and data collected that this was a mixed methods
study. There is need for consistency in describing methods. Recruited through purposeful
sampling for a qualitative but intervention study? Authors state it’s a qualitative study but
methods description is for an experimental study that employed serial data collection. What
about the survey data that was collected? I would suggest that authors describe the overall study
design then state that the manuscript will focus on the qualitative findings of the study. Then
describe how the qualitative portion of the study was conducted using the qualitative research
methods and terminology. Such terminology would include recruitment purposive sampling,
data collection, transcription, analysis approach. Include qualitative data analysis method, was
it thematic? If so then describe and on the findings then present the themes with supporting
excerpts.  Because quantitate data and methods are mixed with qualitative methods and none
are fully explained is confusing.
Findings are also mixed with quantitative and qualitative. While qualitative findings are
described generally on the findings section, the actual findings are located under discussion.
Authors should consider rewriting findings section to remove findings from discussion and
present them under findings section. The findings as presented under discussion could benefit
from another level of analysis where themes are identified and presented with representing
excerpts.
More elaborate engagement of a theory is needed throughout the manuscript; introducing the
theoretical framework underpinning the study early could better position the authors’ findings.
Authors should consider adding a demographic characteristics of the sample in the text, currently
demographic data is presented only on a table. Demographic characteristics of the CHWs are
not presented.
3. Methodological assessment: Inductive approach? Appropriate method and design? Is the
sample appropriate and adequate? Are data saturated? Theoretical analysis? Linked with theory
and/or praxis?
Study approach seems appropriate. A clear presentation that this manuscript focuses on
qualitative data collected would help in understanding the methods. As presented, the authors
designed an intervention, and used FGD and Individual interviews in addition to surveys. The
process of coding qualitative data is described in the COREQ table but not in the manuscript
text. Was data saturation achieved with the qualitative interview data? Authors state in the
COREQ table that saturation was reached with same responses in the surveys.  Usually for
qualitative studies saturation is evaluated during qualitative interviews. The rational for using
qualitative approach to assess the acceptability and feasibility of the intervention is not clear. It
is also not clear how many interviews were conducted with the CHWs given the manuscript is
focused on CHWs. In addition to interviews from PPAs which are well described, it would be
beneficial to know how many interviews were conducted with CHWs, what kind of interviews
(individual interviews or FDD) and what kind of questions were asked.  It is unclear how many
interviews total were conducted.   Were the interviews conducted in English or Kiswahili or
another language? Was there a need for translation of interviews into English and how was that
done?  For instance, how did the authors reconcile words that do not have direct translation into
English? Authors should also include measures used to validate themes. Where the transcripts
independently coded by each research member and the emerging codes compared adjusted?
How did the authors include member checking to validate the findings?
First sentence under discussion states that the CHWS found the intervention useful. More needs
to be said for example how did the CHW find the intervention useful? Did they feel well prepared
to deliver the intervention?  Under discussion, authors should consider first presenting the overall
themes from the study, then offer a discussion of the findings in relation to other studies that
have been done in this topic in Kenya or sub-Saharan Africa or elsewhere but relevant.
4. Adherence to ethical standards?
Ethical standards adherence was ensured
5. Manuscript style and format: (Please evaluate writing style, organization, clarity, grammar,
appropriate citations, etc.). Is this manuscript unnecessarily long?
Manuscript could benefit from some reorganization mainly in the findings section as noted above
and adding a discussion that engages the findings and the literature.  Methods section would
need a clear review for consistency so that qualitative methods design and language is used
throughout the manuscript. Focusing the manuscript on the study aim as presented in the abstract
and reorganizing findings section to include themes as subheadings and removing excerpts from
discussion could help streamline the manuscript and reduce the length.