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, data on whether they can be feasibly and cost-effectively implemented is lacking, and integration of mental health care into routine HIV programming remains rare. Mozambique, a low-income country, has the second highest number of new HIV infections in Eastern and Southern Africa, and just 54% of YLWH there are currently on antiretroviral therapy (ART). Recognizing the importance of mental health to optimal HIV care continuum outcomes, the Mozambican Ministry of Health has begun scaling up the Common Elements Treatment Approach (CETA) for people living with HIV, delivered by psychologists within the National Health System. CETA is a modular, transdiagnostic intervention developed for use in low- and middle-income countries, with demonstrated effectiveness in treating common mental disorders (CMD, i.e., depression, anxiety, PTSD) in Mozambican YLWH. However, like other high HIV- burden contexts, the prevalence of CMD among Mozambican YLWH (~10-20%) exceeds the resources available to deliver this already streamlined, individual intervention to all those needing care. To reduce the treatment gap, there is an urgent need for effective, more efficient mental health treatment options for YLWH. Leveraging our team’s research-service-policy partnership, we propose testing a novel, stepped-care model to streamline mental health services for YLWH within the Mozambican National Health System. We aim to integrate Interpersonal Psychotherapy-Adolescent Skills Training, an evidence-based intervention for youth experiencing mild-moderate CMD, within existing 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 approach to delivering evidence-based mental health care using peer-providers and integrated within HIV support groups, which may efficiently and synergistically improve mental health and HIV care continuum outcomes. Results can directly inform mental health and HIV programming in Mozambique and may serve as a model for other resource-limited contexts.
