Implementing Evidence-Based Treatment for Common Mental Disorders in HIV Clinics in Ukraine - PROJECT SUMMARY Common mental disorders adversely affect health among people with HIV (PWH) and are more prevalent among PWH than in the general population. Psychological and behavioral mechanisms sustain these common mental disorders, and negatively affect health behaviors, such as adherence to antiretroviral therapy (ART). In addition, existing evidence, including after disasters in the US, demonstrate that emergency settings can exacerbate mental health conditions, which in turn challenge ART adherence. Thus, evaluating interventions that can improve mental health outcomes and associated HIV outcomes is critical for all populations affected by emergencies, including in the US. Due to the ongoing war in Ukraine, there is a unique opportunity to evaluate mental health interventions adapted to PWH in an active emergency setting. After the full-scale Russian invasion in 2022, evidence now suggests that rates of mental disorders in Ukraine are rising. Further, the HIV epidemic in Ukraine is substantial, with nearly 260,000 PWH; this represents a much higher prevalence than in the US. All together, conducting this research in a foreign country, which has a significant mental health and HIV burden, will allow for more efficient and innovative research; this setting will also allow for research targeting mental health interventions in emergency settings, which would greatly limit recruitment in the US. The objective of this K23 application is to adapt the Common Elements Treatment Approach (CETA), by incorporating the single-session Life Steps ART adherence intervention, to reduce mental health symptoms among PWH in Ukraine’s emergency setting. CETA is an evidence-based, cognitive behavioral therapy-informed intervention that has been shown to reduce symptoms of the most common mental disorders experienced in emergencies: depression, anxiety, and posttraumatic stress. While cognitive behavioral therapy-based interventions can mitigate psychological and other barriers to ART, CETA does not yet include an ART adherence module and has not been tested for use for PWH in emergency settings. The following aims are proposed: (1) To define relevant clinical and contextual factors for adapting CETA for delivery in HIV clinics and for integrating Life-Steps into the existing protocol; (2) To determine the feasibility, acceptability, and preliminary efficacy of the adapted CETA plus Life-Steps intervention; and (3) To estimate potential mediators and moderators of the adapted CETA plus Life-Steps intervention. The benefit to the US of completing this research is that this project will develop a scalable mental health plus medication adherence intervention that can be quickly translated to HIV care settings in the US, which similarly struggles with targeted HIV and mental health interventions in low-resourced, emergency settings.
