IDEAS for Hope: A Brief Telehealth Intervention to Reduce Suicide Risk and Improve HIV Care Engagement in Tanzania - Suicide is a leading cause of death among people living with HIV (PLWH) worldwide and PLWH are more than three times as likely to die by suicide compared to people without HIV. Mental health challenges are also closely linked to poor HIV outcomes, including lapses in clinic attendance, poor medication adherence, risk of HIV transmission, and AIDS-related death. Yet when PLWH receive mental health treatment that addresses barriers to HIV treatment adherence, both mental health and HIV outcomes improve. We are developing innovative approaches to bridge the mental health treatment gap, including telehealth and nurse-led counseling interventions with clear potential to improve HIV outcomes in the United States and global settings. We previously developed and conducted a pilot feasibility randomized controlled trial of IDEAS for Hope, a 3-session telehealth counseling intervention, to reduce suicide risk and improve HIV care engagement in Tanzania. The IDEAS for Hope intervention, grounded in Motivational Interviewing, CBT, and Problem-Solving Therapy frameworks, facilitates HIV education, stigma reduction, and social support to address predictors of suicide risk. The pilot trial with 60 PLWH experiencing suicidal ideation showed clear feasibility and acceptability of IDEAS for Hope, as well as strong trends toward efficacy to reduce suicide risk. The objective of this research is to develop a scalable implementation package to expand care, reduce suicide risk, and improve HIV care engagement. In Aim 1, we will determine the effectiveness of IDEAS for Hope to reduce suicide risk and improve HIV care engagement in an individually randomized controlled trial in Tanzania. Based on our pilot trial, we hypothesize that IDEAS for Hope will reduce suicidal plan and intent to near zero and will improve HIV care engagement by 17% at 6-month follow-up, which will be statistically superior to brief safety planning. In Aim 2, we will explore mechanisms of change to identify how and for whom IDEAS for Hope is most effective. Hypothesized mediators of suicide risk and HIV care engagement include self-efficacy, depression, anxiety, and stigma; potential moderators include sex, age, and severity of baseline symptoms. Intervention refinement in a low-cost, high-burden global setting has great potential for adaptation to the rural U.S. In Aim 3, we will evaluate implementation outcomes, including cost-effectiveness. We hypothesize that IDEAS for Hope will be effectively expanded to 12 clinics, including rural sites, with a favorable Incremental Cost-Effectiveness Ratio. Structured surveys and qualitative interviews with patients and providers will assess fidelity and sustainability outcomes for implementation. We plan to adapt and test IDEAS for Hope in a rural U.S. setting in the next phase of this research, as this nurse-led telehealth intervention has great potential to reduce rural mental health treatment gaps and improve the health of Americans. The research is innovative, yet fundamentally essential, and supports NIH Strategic Objectives to prevent suicide across the lifespan, address mental health comorbidities of HIV, and strengthen mental health and HIV outcomes in the U.S.
