Streamlining Mental Health Interventions for Youth Living with HIV in Low- and Middle-Income Countries
Teri Senn, Ph.D.
Susannah Allison, Ph.D.
Division of AIDS Research
This concept aims to solicit research to target gaps in our knowledge about how best to address the mental health needs of youth living with HIV (YLWH) in low- and middle-income countries (LMICs). There are two main goals of the concept. The first is to increase the number of mental health interventions tailored to the unique needs of YLWH, both in terms of their developmental needs as well as the issues related to living with a chronic, stigmatized disease. The second goal is to ensure that interventions are streamlined for implementation in resource-limited settings.
In 2020, there were approximately 1.75 million YLWH globally, the majority living in sub-Saharan Africa. YLWH have some of the poorest outcomes along the HIV care continuum, including lower rates of viral suppression relative to adults living with HIV. Adolescence and young adulthood are unique periods of development, when there is increased onset of common mental disorders (which, in turn, are associated with poor HIV care continuum outcomes), rapid brain development, shifting social influences, and heightened concern around stigma. In addition, YLWH may face unique challenges as they transition from pediatric to adult HIV services; navigate new peer and romantic partner relationships, which may include pregnancy and parenthood; and potentially move out of the family home.
There are effective interventions to address mental disorders among adults living with HIV. Some studies indicate these interventions also improve HIV care continuum outcomes for adults, particularly when combined with antiretroviral therapy adherence counseling. Although researchers have identified effective interventions targeting mental disorders among YLWH, few studies on youth have been conducted in LMICs, and fewer still have investigated whether these interventions impact HIV care continuum outcomes. Mental health interventions for YLWH may need to be adapted to their unique developmental contexts. Additionally, many LMICs have a paucity of mental health service providers, so interventions that can be streamlined and delivered by non-mental health specialists are needed.
Research topics may include, but are not limited to: adapting and pilot testing interventions for impact on mental health and HIV outcome(s); determining the optimal points to intensify or lessen a mental health intervention for YLWH; determining the minimal dose or critical intervention components needed to achieve clinically significant improvements; matching the most effective intervention to the appropriate person; and testing implementation strategies to lessen provider burden while maintaining the quality of intervention delivery.