Telehealth to Reduce Suicidality and lmprove HIV Care Engagement in Tanzania

拟议的K 08职业发展奖将为Knettel博士提供培训和指导， 成为一名独立的临床科学家，专注于开发新颖但可扩展的心理健康干预措施 在资源有限的环境中。拟议研究的目的是评估可行性和可接受性 护士提供的3次远程保健干预，以减少自杀和改善艾滋病毒护理参与 在坦桑尼亚基利曼哈罗地区的艾滋病毒感染者中。自杀是死亡的主要原因， 艾滋病毒感染者和精神健康障碍是艾滋病毒护理不力的主要原因 艾滋病毒/艾滋病感染者的参与、生活质量降低、传播风险增加和死亡率增加。相反地， 将艾滋病毒携带者与有针对性的心理健康支持联系起来，可以改善这些关键的健康结果。远程医疗 咨询是一种在资源匮乏的环境中进行心理健康治疗的成本效益高的创新方法 例如坦桑尼亚，有可能“跳过”效率较低的办法，方便地扩大服务。博士 Knettel是一位有执照的心理学家，拥有强大的心理健康临床医生和研究人员背景， 艾滋病毒，包括在坦桑尼亚的广泛经验。这个K 08奖项将支持他实现以下目标 培训目标：1）获得临床模型的专业知识，以解决艾滋病毒携带者的自杀意念; 2）获得 通过以下方式开发和评估心理健康干预措施的独立顾问水平技能 临床试验研究; 3）发展在资源有限的环境中领导转化研究的能力;以及4） 熟练掌握远程保健治疗和调整干预措施以提供远程保健服务。支持这些 目标，Knettel博士提出了一个由大卫戈德斯通博士领导的指导小组，他是该领域的领先临床科学家。 自杀预防领域;共同导师Blandina Mmbaga博士将指导艾滋病毒转化研究的培训， Michael Relf博士是艾滋病毒护理参与临床试验方面的专家; 博士Sylvia Kaaya是坦桑尼亚精神病学家，专门从事行为干预的适应。专家 顾问Ryan Shaw和Elizabeth Turner博士提供远程医疗和临床试验方面的进一步指导 生物统计学培训目标将通过一个全面的培训计划来实现， 导师制，课程，研讨会，实验室会议，并在国际研究网站的合作。的 拟议的研究将包括目标1：确定远程保健干预的理想特征， 坦桑尼亚临床背景下的自杀和艾滋病护理参与，目标2：完善干预内容 在坦桑尼亚当地研究咨询委员会的支持下，目标3：在试点中测试远程医疗模式 随机对照试验。鉴于远程保健方法可改善获得治疗的机会的新证据 和减少健康差距，干预措施有很大的潜力，以支持NIMH的战略目标， 解决精神健康共病问题，加强艾滋病毒护理的连续性。拟议的研究还将 为Knettel博士的第一个R 01提案提供初步数据，该提案将在K 08奖项的最后一年提交。

The proposed K08 Career Development Award will provide Dr. Knettel with the training and mentorship to become an independent clinical scientist focused on developing novel, yet scalable mental health interventions in resource-limited settings. The objective of the proposed research is to assess the feasibility and acceptability of a 3-session, nurse-delivered telehealth intervention to reduce suicidality and improve HIV care engagement among adults living with HIV in the Kilimanjaro Region of Tanzania. Suicide is a leading cause of death among people living with HIV (PLWH) worldwide and mental health disorders are key contributors to poor HIV care engagement, lower quality of life, higher transmission risk, and increased mortality among PLWH. Conversely, connecting PLWH with targeted mental health support improves these critical health outcomes. Telehealth counseling represents a cost-effective, innovative approach to mental health treatment in low-resource settings such as Tanzania, with the potential to `leapfrog' less efficient approaches and expediently extend services. Dr. Knettel is a Licensed Psychologist with a strong background as a clinician and researcher in mental health and HIV, including extensive experience in Tanzania. This K08 award will support him to achieve the following training objectives: 1) acquire expertise in clinical models to address suicidal ideation among PLWH; 2) obtain independent investigator-level skills in the development and evaluation of mental health interventions via clinical trial research; 3) develop the capacity to lead translational research in resource-limited settings; and 4) gain proficiency in telehealth treatment and adaptation of interventions for telehealth delivery. To support these objectives, Dr. Knettel proposes a mentoring team led by Dr. David Goldston, a leading clinician-scientist in the area of suicide prevention; Co-Mentor Dr. Blandina Mmbaga will guide training in translational HIV research in Tanzania; Co-Mentor Dr. Michael Relf is an expert in clinical trials for HIV care engagement; and Co-Mentor Dr. Sylvia Kaaya is a Tanzanian psychiatrist specializing in the adaptation of behavioral interventions. Expert consultants Drs. Ryan Shaw and Elizabeth Turner offer further mentorship in telehealth and clinical trial biostatistics. Training objectives will be met through a comprehensive training plan involving in-person mentorship, coursework, seminars, lab meetings, and collaboration at the international research site. The proposed study will include Aim 1: Identifying the desired characteristics of a telehealth intervention for suicidality and HIV care engagement in the Tanzanian clinical context, Aim 2: Refining intervention content with support from a local study advisory board in Tanzania, and Aim 3: Testing the telehealth model in a pilot randomized control trial. Given emerging evidence for telehealth approaches to improve access to treatment and reduce health disparities, the intervention has great potential to support NIMH strategic objectives to address mental health comorbidities and strengthen the HIV care continuum. The proposed study will also provide preliminary data for Dr. Knettel's first R01 proposal, to be submitted in the final year of this K08 award.