syv: a mental health intervention to improve hiv outcomes in tanzanian youth

Conditions: HIV-1-infection; Mental Health Issue; Adherence, Medication

Summary: the overall objectives of this proposal are to support positive coping strategies that bolster mental health and lead to improved hiv outcomes among young people living with hiv (yplwh). the central hypothesis is that syv (sauti ya vijana, the voice of youth) will be effective to improve antiretroviral therapy (art) adherence and virologic suppression in yplwh in tanzania. the rationale for this project is that by targeting mental health, which is strongly associated with medication adherence, that this will effectively improve adherence and thereby hiv viral suppression. the central hypothesis will be tested in three aims in a hybrid type-1 effectiveness-implementation trial.

the rigorous experimental design includes a pilot study followed by a parallel-arm randomized control trial (rct). the pilot will include approximately eight consenting members of the youth community advisory board (cab) at each site location prior to the rct. if a youth cab does not currently exist at each site, one will be formed. although the investigators have strong pilot data for the syv intervention from moshi, the pilot test proposed herein will help ensure recruitment, enrollment, intervention delivery, supervision, measurement technology and logistics run as expected at each site (moshi, mbeya, mwanza, ifakara). the pilot study will be comprised of 8 participants recruited at each site. subsequently, for the rct, we will individually randomize up to 750 participants to receive the syv intervention or soc (standard of care) to achieve 90% power to detect a 10 percentage point difference between arms in the primary outcome of virologic suppression at the two-tailed 5% significance level, accounting for clustering by syv group in the intervention arm. the intervention will be rolled out across four main sites, in four different tanzanian regions, and in four waves separated in time by 6 months. there will be two syv groups per wave at each site (\~8 groups per site) a study visit for all participants will be conducted baseline and approximately 4 months (t1), 6-, 12-, and 18-months post-baseline (t2, t3, t4) with 6-months post baseline being the primary endpoint. at 12 months post-baseline (t3), those randomized to the syv intervention will receive a one-session syv booster to improve content retention and study engagement as has been shown in prior studies.

Eligibility criteria:
inclusion criteria: * youth between the ages of 10 and 24 years of age * attending the enrolling adolescent hiv clinic * are fully disclosed and aware of their hiv status * receiving art for a minimum of 6 months * if ≥ 18 years, able to understand the project and provide written informed consent * if \<18 years, a parent or guardian must provide written permission and participant must be able to assent * all adolescents must also commit to attending the 10 weekly syv sessions and 2 individual sessions exclusion criteria: * active psychosis * developmental delay, or cognitive disability that precludes active participation in consent process, intervention, and assessment interviews

Keywords: hiv-1 adolescent youth mental health africa tanzania medication adherence