Evaluation of peer-delivered, integrated mental health and HIV support groups for stepped management of common mental disorders among Mozambican Youth Living with HIV - PROJECT SUMMARY Youth living with HIV (YLWH) have high rates of mental health problems, and poor mental health is associated with worse HIV care continuum outcomes. Though the evidence for mental health interventions effective at improving mental health and HIV outcomes among YLWH is growing, the prevalence of common mental disorders (CMD, i.e., depression, anxiety, PTSD) among YLWH (~10-20%) exceeds the human resources available to deliver these specialized interventions, and integration of mental health care into routine HIV services remains rare. To reduce the mental health burden in YLWH, there is an urgent need for more efficient treatment options. Here, we propose testing a novel, stepped-care model to streamline mental health services for YLWH. We evaluate our model in Mozambique as it provides a unique setting to study integration of mental health and HIV services at scale. Mozambique has one of the largest populations of YLWH globally, supporting timely recruitment for a large trial, and an established national platform for delivering specialized mental health care to YLWH through the Common Elements Treatment Approach (CETA), providing a high-intensity intervention that is already implemented within routine HIV services. Together, these features enable a cost-efficient test of our stepped-care approach in a real-world context that would not be feasible in other settings. We first aim to integrate Interpersonal Psychotherapy-Adolescent Skills Training, an evidence-based intervention for youth experiencing mild-moderate CMD, within peer-led HIV support groups to develop an evidence-based, low-intensity intervention that simultaneously promotes mental health and HIV outcomes, i.e., CombinADO-MH (Aim 1). We will then conduct a Hybrid Type I Effectiveness-Implementation cluster randomized control trial to evaluate the clinical and implementation outcomes of delivering stepped care (CombinADO-MH for YLWH with mild-moderate CMD symptoms, CETA for YLWH with severe CMD symptoms) compared to CETA alone (all YLWH with mild-severe CMD symptoms). We hypothesize that CombinADO-MH will perform similarly to CETA at reducing CMD symptoms, increasing ART adherence, and increasing viral load suppression (Aim 2) but will have a greater reach and be a more cost-effective approach (Aim 3), producing greater overall benefits to YLWH. Addressing NIMH Strategic Goals 3 and 4, this pragmatic trial will provide data on the effectiveness, implementation, and cost of an innovative stepped-care approach to delivering evidence-based mental health care using peer providers and integrated HIV services. Although conducted in Mozambique, the proposed work addresses challenges highly relevant to the U.S., including shortages of mental health providers, integration of behavioral health into chronic disease services, and efficient allocation of limited specialty mental health resources. Findings will generate generalizable evidence for scalable and cost-effective stepped-care delivery models that can inform programs serving youth living with HIV in the U.S. and other settings.
