The overall objectives of the proposed research are to develop a brief telehealth counseling intervention to provide support for people living with HIV and experiencing suicidal ideation, and to support HIV care engagement. The investigators hypothesize that a brief telehealth counseling intervention will be safe (participants in the clinical trial will not have increased risk of suicidal behavior), acceptable (high patient retention and satisfaction, high fidelity), and will demonstrate preliminary efficacy (reduced suicidal ideation, improved care engagement, improved mental well-being).
The objective of the proposed research is to assess the feasibility and acceptability of a 3-session, nurse-delivered telehealth intervention to reduce suicidality and improve HIV care engagement among adults living with HIV in the Kilimanjaro Region of Tanzania. Suicide is a leading cause of death among people living with HIV (PLWH) worldwide and mental health disorders are key contributors to poor HIV care engagement, lower quality of life, higher transmission risk, and increased mortality among PLWH. Conversely, connecting PLWH with targeted mental health support improves these critical health outcomes. Telehealth counseling represents a cost-effective, innovative approach to mental health treatment in low-resource settings such as Tanzania, with the potential to expediently extend services. The proposed study will include Aim 1: Identifying the desired characteristics of a telehealth intervention for suicidality and HIV care engagement in the Tanzanian clinical context, Aim 2: Refining intervention content with support from a local study advisory board in Tanzania, and Aim 3: Testing the telehealth model in a pilot randomized control trial. Given emerging evidence for telehealth approaches to improve access to treatment and reduce health disparities, the intervention has great potential to support NIMH strategic objectives to address mental health comorbidities and strengthen the HIV care continuum.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
60
Participants will receive three counseling sessions at two week intervals, delivered by telehealth by a trained psychiatric nurse, focused on managing suicidal ideation and enhancing HIV care engagement.
Participants will receive a brief, 10-15 minute counseling session, delivered by telehealth by a trained psychiatric nurse, focused on safety planning.
Majengo Health Centre
Moshi, Tanzania
Mawenzi Hospital
Moshi, Tanzania
Number of Participants With Suicidal Ideation
Columbia-Suicide Severity Rating Scale (C-SSRS) items measuring suicidal thoughts (yes/no), intent (yes/no), and plan (yes/no). Reported here are the number of participants who responded 'yes' to each of the items.
Time frame: 3 months post enrollment
Number of Participants With a Gap in HIV Care Engagement
Participant medical records were reviewed after the 3-month follow-up survey to identify whether they had a gap in care during the study period, defined as 6 or more days where they did not have enough prescribed medication on hand to maintain adherence between HIV clinic appointments.
Time frame: 3 months post enrollment
HIV Medication Adherence, as Measured by Number of Participants Who Report Adherence Challenges
During the baseline and follow-up surveys, participants were asked two questions related to their adherence to antiretroviral medication: "Think about the last 14 days. On how many days did you miss taking your HIV pill(s)?" and the same question with a 90 day recall period. Adherence challenges were coded yes/no at each time point, defined as (1) missing 3 or more days of medication in the past 14 days or (2) missing 6 or more days in the past 90 days.
Time frame: 3 months post enrollment
Viral Load
Extraction of routine HIV viral load testing from the patient medical record at baseline and 3-months post study enrollment.
Time frame: Baseline, 3 months Post Enrollment
Depression
Patient Health Questionnaire (PHQ-9), 9 items, score 0-27 with higher indicating more depression
Time frame: 3 months post enrollment
HIV Stigma
HIV Stigma Scale (HSS), 12 items, score 12-48 with higher indicating more stigma
Time frame: 3 months post enrollment
Number of HIV Disclosures Made by Participants
Self-reported disclosures to partner, family, friends, others (yes/no)
Time frame: 3 months post enrollment
Total Number of HIV Disclosures Made by Participants
Time frame: 3 months post enrollment
Social Support
Perceived Availability of Support Scale (PASS), 7 items, score 7 to 35 with higher indicating more social support
Time frame: 3 months post enrollment
Acceptability of Intervention
10 items adapted from the Client Satisfaction Questionnaire (CSQ), score 10 to 40 with higher indicating greater satisfaction with the intervention
Time frame: 3 months post enrollment
Hopelessness
Beck Hopelessness Scale (Balsamo Short Form), 9 items, score 0 to 9 with higher indicating more hopelessness
Time frame: 3 months post enrollment
Reasons for Living
Brief Reasons for Living Inventory, 12 items, score 12 to 72 with higher indicating more reasons to live
Time frame: 3 months post enrollment
Quality of Life (Overall)
The World Health Organization Quality of Life Brief Version (WHOQOL-BREF), 2 items, score 2 to 10 with higher indicating better quality of life
Time frame: 3 months post enrollment
Quality of Life (Health Satisfaction)
The World Health Organization Quality of Life Brief Version (WHOQOL-BREF), 2 items, score 2 to 10 with higher indicating better quality of life
Time frame: 3 months post enrollment
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