Streamlined Treatment and Evidence-based Adolescent counseling and Medication Support (STREAMS)

STREAMS Abstract Interventions that use a combination approach—as recommended by UNAIDS—to address mental health in low- and middle-income countries (LMICs), are crucial to achieving the UNAIDS 95-95-95 targets, yet few such evidence-based combination interventions currently exist for the 1.7 million adolescents living with HIV (ALWHIV) in Africa. We propose Streamlined Treatment and Evidence-based Adolescent counseling and Medication Support (STREAMS) to evaluate a combination intervention comprising of streamlined interpersonal psychotherapy groups (IPT-G) tailored to adolescents (15-19 years) and streamlined family strengthening and treatment adherence counseling in rural Uganda. In our pilot work, PI Kreniske (K01MH122319) collaborated with StrongMinds and Brown School’s International Center for Child Health and Development (ICHAD) to demonstrate feasibility and acceptability of a streamlined text message based PHQ-9 screener to assess depression. Adolescents were successfully linked to StrongMinds 6-week IPT-G counseling and experienced a reduction in depressive symptoms. StrongMinds IPT-G counseling is tailored to the Ugandan context and has been reduced from a program based on 16 IPT-G sessions to the streamlined 6 sessions. To date, this approach has not been evaluated among ALWHIV. To address HIV counseling and adherence, we propose streamlining Suubi+Adherence (R01HD074949; PI Ssewamala), a family-based combination intervention combining economic empowerment intervention with medication adherence counseling for ALWHIV in Uganda that improves antiretroviral (ART) treatment adherence but has not been examined specifically among youth experiencing symptoms of depression. STREAMS will be implemented across 24 ICHAD-affiliated HIV health clinics within the greater Masaka region of Uganda—a region heavily impacted by HIV compared to national averages. We will use a Type I Hybrid design 3-arm cluster-randomized trial to evaluate effectiveness at both reducing depressive symptoms and improving ART adherence, with the secondary aim of characterizing the combined interventions’ feasibility and acceptability comparing (1) streamlined IPT-G and streamlined Suubi+Adherence in combination, (2) streamlined IPT-G and SOC ART counseling (3) SOC mental health and SOC ART counseling. Randomized at the clinic level, adolescents will be consecutively sampled, and those who screen positive for depressive symptoms on the mobile phone administered PHQ-9 will be enrolled. Using Consolidated Framework for Implementation Research (CFIR) informed in-depth interviews and analysis, we will systematically assess barriers and facilitators to accessing mental health care and adhering to ART across CFIR domains (e.g., individual characteristics, inner – healthcare settings) to inform scalable changes to care to support HIV treatment among ALWHIV in rural Uganda. STREAMS examines if our mobile phone screening tool along with a combination of streamlined StrongMinds IPT-G and streamlined Suubi+Adherence ART counseling, provides a low-cost, efficacious, and scalable approach for improving mental health and ART adherence.