Developing a suicide prevention intervention for people with HIV in South Africa - PROJECT SUMMARY/ABSTRACT Background: Suicide in people with HIV (PWH) is an unaddressed public mental health concern in South Africa. Research on suicidal ideation and behavior is scant in low- and middle-income countries (LMIC), despite evidence suggesting that PWH are confronted with synergistic psychosocial and situational stressors that increase their risks for suicide and adversely affect HIV care engagement, including delayed treatment initiation, poor adherence, and viral instability. Yet, there has been no research investigating behavioral interventions for suicide in PWH in South Africa. Research: The study’s specific aims are to 1) explore primary healthcare-level suicide treatment practices, gaps, needs, and ideal intervention characteristics among stakeholders and PWH; 2a) develop a brief behavioral intervention addressing suicide and HIV care engagement (MI-Cope-Care); 2b) refine MI-Cope-Care in an iterative, sequential pre-pilot study; and 3) evaluate the feasibility, acceptability, and preliminary effectiveness of MI-Cope-Care in a pilot randomized controlled trial. If found to be feasible and acceptable, MI-Cope-Care will be the first suicide intervention for PWH in South Africa. This study supports NIH HIV/AIDS Research Priorities to reduce mental health comorbidities of HIV and strengthen the HIV care continuum. Candidate: I am a research psychologist with expertise in cross-cultural psychology and community- based behavioral interventions in resource-constrained settings. This career development award will afford me the necessary skills, training, mentorship, and protected time to become an independent, NIH-funded investigator developing interventions that address suicide and HIV care engagement among PWH in South Africa and other low- and middle-income countries (LMICs). Mentorship: Dr. John Joska will serve as my primary SA- based mentor given his experience in mental health and HIV and implementing behavioral interventions in South Africa. Dr. Kathleen Sikkema will be my primary US-based mentor due to her expertise in trauma and HIV, and experience in trial design and intervention development in resource-limited settings. My co-mentors will be Dr. Jason Bantjes given his expertise in suicide research in South Africa, and Dr. Ewa Czyz because of her experience in developing brief interventions for suicide risk. I have assembled a strong team of study consultants: Dr. Duleeka Knipe (social determinants of suicide); Dr. Jessica Magidson (Motivational Interview-informed interventions); Dr. Martina Pavlicova (biostatistics); and Dr. Duovandre Jansen (suicide risk management). Training: I propose to obtain training in intervention development using the NIH Stage Model, gain expertise in treatment frameworks for suicide ideation among PWH, and obtain competency in clinical trial design and longitudinal data analysis. Not only will these training goals provide the necessary skills to develop, evaluate, and implement suicide interventions, but also provide the platform to emerge as a global leader in suicide in LMIC.
