Esther Kip, PhD, is a WARMHEART Fellow in Malawi, a postdoc training program named for the “warm heart of Malawi.” In the following interview, she explains her interest in adolescent mental health, how her research is building momentum, and a UNICEF experience remains a driving force behind her work.
What is the WARMHEART Fellowship?
The Malawian Program for Mental Health Research Training (WARMHEART) is funded by the U.S. National Institutes of Health Fogarty International Center, and administered by the Institute for Global Health and Infectious Diseases, with UNC Project Malawi and the Kamuzu University of Health Sciences (KUHeS).
Led by Kazione Kulisewa, MBBS, and Bradley Gaynes, PhD, WARMHEART is creating a pool of mental health researchers trained as leaders, and able to collaborate with other disciplines and policymakers to address the role of psychiatric illness across the lifespan. In fact, Dr. Kulisewa is the country’s first psychiatrist in a generation, having completed his medical training two years ago. KUHeS enthusiastically supports expansion of its mental health faculty and research. Multiple funded mental health research grants provide a rich opportunity for mentored research experiences, and the Ministry of Health mental health unit is committed to translating research to practice.
What is your training project?
I serve as principal investigator for an implementation research study focused on improving psychosocial care and mental health support for adolescents living with HIV (ALHIV) in Malawi. Few local mental health studies have demonstrated that ALHIV have a high burden of depression, yet the mental health treatment gap remains high. Approaches to the successful implementation of mental health programs aimed at screening and treating prevalent mental health conditions are therefore needed. The study is called “Implementation of strategies and evaluation of the adapted psychosocial screening to improve adolescents living with HIV outcomes in Teen Club programs in Zomba district, Malawi.” My WARMHEART mentor is Dr. Melissa Ann Stockholm.
Tell us about your research experience.
The HEADSS tool is a multi-dimensional social and mental health screening tool that has proven efficacy and utility in varied high-income and low-income settings and has also been successfully trialed in Malawi. Despite these benefits, it remains underutilised by adolescent health care providers in Malawi. My first study in 2018 focused on the “Implementation barriers of the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in the Teen Club program in two districts, Malawi.” We aimed to understand the factors that contributed to the under-utilization as a significant step in the possible scale-up of its use in Malawian adolescent ART care settings (Teen Club programs). This effort was supported by the Sub-Saharan Africa Regional Partnership (SHARP).
The Institute for Global Health & Infectious Diseases administered SHARP, and my primary mentor was Dr. Bradley Gaynes, also funded by the NIH Fogarty International Center. I was selected as one of the first in the SHARP mentored research grant program. Our findings showed that the HEADSS tool lacked appropriate cultural context.
Prior to my postdoctoral fellowship awards, I was a fellow through the UJMT Fogarty Global Health Consortium. This program provides structured training, mentorship, and funding that supported my development as a global health leader and implementation research scientist. My primary mentors were Drs. Vivian Go and Mina Hosseinipour. Their combined expertise in implementation science and global mental health has greatly guided my research.
Then, I was awarded the FGHF program in 2021, which built on the formative study, and we adapted the current existing psychosocial screening tool (HEADSS) to be more appropriate to the cultural situation and living conditions in the Malawian context. This award was supported by a consortium between UNC-Chapel Hill, Johns Hopkins University, Morehouse School of Medicine & Tulane University (UJMT) and funded by the NIH Fogarty International Center.
How did you become interested in adolescent health?
My passion for adolescent health was shaped by decades of work in HIV care across Southern and Eastern Africa. A particularly moving moment was when I was involved in a consultancy by UNICEF Malawi on National Plan of Action for vulnerable Children in Malawi. During the survey, I found out that ALHIV were going through a lot of psychosocial issues at home and the communities. Stigma and discrimination were mentioned in all the districts we conducted the focus group discussions with the ALHIV. Most of them questioned why they were HIV positive when they’d heard that HIV is mostly transmitted sexually. Yet, they had not slept with anyone. Most of the ALHIV felt bitter about taking antiretroviral drugs and some were non adherent. Their words underscored for me the urgent need to integrate mental health into HIV care. This personal encounter remains a driving force behind my work.
How has WARMHEART helped you advance your goals?
This experience significantly enhanced my leadership and research skills, and deepened my understanding of the psychosocial needs of ALHIV. It aligns with my long-term goal of strengthening adolescent HIV care in Malawi and Sub-Saharan Africa through mental health integration and health systems research. My main goal is to give hope to ALHIV who are struggling with stigma, discrimination, depression and other mental health conditions and that could be done through my contribution to the Ministry of Health (MoH) by addressing the gaps we have identified during our exploratory formative study on HEADSS psychosocial screening implementation. I would like to be an asset to MoH by developing new strategies or innovations in ALHIV mental health research and programming. I believe that if an intervention study would be implemented with innovative strategies, this might improve the treatment outcome and subsequently enhance the quality of life of ALHIV. I have always enjoyed building capacity of young researchers and other cadres so I will continue doing that as well and this will be in implementation science and mental health. Yes, there will be follow-up. We are currently exploring opportunities for scale-up and further evaluation of the adapted screening tool, as well as ongoing dissemination of findings.
Where have you published or presented your recent studies?
Following are two key published papers:
- Stigma and mental health challenges among adolescents living with HIV in selected adolescent specific antiretroviral therapy clinics in Zomba District
Authors: Esther C. Kip, Michael Udedi, Kazione Kulisewa, Vivian F. Go, Bradley N. Gaynes - Barriers and facilitators to implementing the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in teen club program in Malawi: health care providers perspectives
Authors: Esther C. Kip, Michael Udedi, Kazione Kulisewa, Vivian F. Go, Bradley N. Gaynes
In addition, three abstracts were presented to the 2023 International AIDS Impact Conference in Stockholm, and the local Kamuzu University of Health Sciences (KUHES) Research Dissemination Conference. I was also awardee of the “AIDS Impact Abstract in Excellence Prize” at AIDSImpact 2023. On behalf of the WARMHEARM program, two abstracts were presented in May, at the AIDS Impact International Conference in Casablanca Morocco.
Since then, I’ve had a productive experience with the AIDSIMPACT Conference (Casablanca, Morocco, May 2025) where my work was highlighted as:
- Two Abstract Presentations (WARMHEART-funded):
“Piloting an adapted psychosocial assessment tool among adolescents living with HIV in Zomba district, Malawi” (Poster Presentation) and
“Training health care professionals to detect psychosocial issues and high-risk behaviors among adolescents living with HIV/AIDS in Zomba, Malawi” (Oral Presentation) - I also chaired one session during the conference and was invited to the scientific dinner.
- A publication pending: “Cultural adaptation of the psychosocial screening tool for adolescents living with HIV/AIDS in antiretroviral therapy program in Malawi” (Anticipated publication in PLOS ONE Journal anytime).
- I’m also piloting an adapted psychosocial assessment tool among adolescents living with HIV in Zomba district, Malawi (Manuscript under review)
- In progress (Drafting/Review): “Training health care professionals to detect psychosocial issues and high-risk behaviors among adolescents living with HIV/AIDS in Zomba, Malawi” (Manuscript being finalized before submission to my two mentors).