Implementing Evidence-Based Treatment for Common Mental Disorders in HIV Clinics in Ukraine

PROJECT SUMMARY From 2010-2020, Eastern Europe reported a 72% increase in new adult HIV infections, representing the highest rate of increase globally. Among the Eastern European countries, the HIV epidemic in Ukraine is one of the largest, with nearly 260,000 people with HIV (PWH). Nevertheless, in 2020, only 54% of Ukrainian PWH were on antiretroviral therapy (ART), and only 51% were virally suppressed. These suboptimal HIV care continuum outcomes are partially attributable to mental disorders, which are more prevalent among PWH generally (and in Ukraine specifically) and have been linked to decreased ART adherence and poor engagement in HIV care. To minimize the adverse effects of impaired mental health on HIV outcomes, creating a pathway to increase access to evidence-based mental health care is a critical public health need. The long- term goal of this applicant is to develop expertise in testing transdiagnostic mental health interventions to improve HIV outcomes among PWH in Ukraine. The objective of this K23 application is to adapt the Common Elements Treatment Approach (CETA), by incorporating the single-session Life Steps ART adherence intervention, to reduce symptoms of depression, anxiety, and posttraumatic stress among PWH in Ukraine. The central hypothesis to be tested is that the adapted CETA plus Life-Steps intervention will improve both HIV and mental health outcomes among PWH in Ukraine. The strong preliminary data supporting this application shows that community psychologists in Ukraine feel they do not have adequate knowledge to deliver mental health treatment but nonetheless have strong interest in learning short-term treatments such as CETA. To test the central hypothesis, the following specific aims are proposed: (1) To define relevant clinical and contextual factors for adapting CETA for delivery in HIV clinics and for integrating Life-Steps into the existing protocol; (2) To determine the feasibility, acceptability, and preliminary efficacy of the adapted CETA plus Life-Steps intervention; and (3) To estimate potential mediators and moderators of the adapted CETA plus Life-Steps intervention. The expected outcome of this K23 is that this applicant will gain the expertise needed in the three critical training areas of HIV and mental health, design of randomized clinical trials, and longitudinal data analysis necessary to achieve research independence. The key innovation is that this study will be the first to combine CETA with Life-Steps and evaluate its preliminary efficacy in a low- or middle-income country setting. The resulting preliminary data will also support a compelling R01 application, to be submitted in year 4 of the K23 award period, to test the adapted CETA plus Life-Steps intervention in a fully-powered, multi-site efficacy study in Ukraine. If successful, the proposed research will have significant public health impact by providing an evidence-based intervention for treating mental health problems among PWH, with attendant implications for addressing the dual mental health crisis and HIV epidemic in PWH populations throughout Eastern Europe.