Adapting the ESTEEM intervention to improve mental health and PrEP uptake among men at risk of HIV

Globally, men at risk of HIV are disproportionately affected by common mental illnesses, including depression and anxiety. The mental health of men at risk of HIV is directly affected by chronic exposure to stressors that uniquely impact them via prejudice events, such as enacted stigma and violence, as well as anticipated and internalized stigma. Behavioral interventions that address the multiple mental and sexual health problems caused by chronic exposure to stress among men at risk of HIV are urgently needed. The goal of this Career Development Award is to expand the candidate’s skillset and prepare him to conduct independent research on scalable behavioral interventions that integrate mental health and HIV services for men at risk of HIV in low resource settings. Through a combination of didactic and applied training and mentorship from leading experts, the candidate will develop expertise in 1) the systematic adaptation of evidence-based interventions; 2) implementation science tools for identifying and evaluating implementation strategies; 3) theory and analysis of mechanisms of change for mental health interventions; and 4) leading culturally appropriate intervention research in low-resource settings. The candidate will apply the knowledge and skills gained through this training to conduct a pilot randomized control trial in collaboration with RAIN, a community-based organization that provides HIV services in Charlotte, NC. Specifically, the candidate will adapt the ESTEEM (Effective Skills to Empower Effective Men) intervention to target pre-exposure prophylaxis (PrEP) uptake for the North Carolina context and to identify implementation strategies (Aim 1). ESTEEM is a skills-building Cognitive Behavioral Therapy intervention that was designed to reduce men’s co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which stress impairs health; it is effective at improving mental health and HIV-related behaviors among men at risk of HIV in the US. He will then pilot the adapted intervention with 80 men at risk of HIV to assess preliminary effectiveness on depression, anxiety, and PrEP uptake, and explore mechanisms of change (Aim 2). Finally, he will assess acceptability, feasibility, and fidelity of the adapted intervention and implementation strategies for future scale-up in other community clinic settings. Findings from this research will inform the development of an R01 proposal for a hybrid type 1 implementation-effectiveness trial to examine effectiveness and implementation sustainability of the scaled-up, adapted intervention. Together, the training, research, and collaborations outlined in the award will support the testing of a scalable mental health intervention with the potential to improve multiple common mental illnesses and PrEP uptake among men at risk of HIV in low-resource settings, contributing to NIMH’s goal of scaling up interventions for populations with the greatest need.