Telehealth to Reduce Suicidality and lmprove HIV Care Engagement in Tanzania

拟议的K08职业发展奖将为Knettel博士提供培训和指导，以 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 在资源有限的情况下。拟议研究的目的是评估可行性和可接受性。 由护士提供的3次远程健康干预，以减少自杀和改善艾滋病毒护理参与度 在坦桑尼亚乞力马扎罗地区艾滋病毒携带者的成年人中。自杀是导致死亡的主要原因 全球艾滋病毒携带者(PLWH)和精神健康障碍是造成艾滋病毒护理不善的关键因素 参与、较低的生活质量、较高的传播风险和增加的死亡率。相反， 将PLWH与有针对性的精神健康支持联系起来，可以改善这些关键的健康结果。远程医疗 咨询代表了一种在低资源环境下进行心理健康治疗的具有成本效益的创新方法 例如坦桑尼亚，有可能“跳过”效率较低的做法，并便利地扩大服务。Dr。 Knettel是一名有执照的心理学家，具有丰富的心理健康临床医生和研究人员背景，并 艾滋病毒，包括在坦桑尼亚的丰富经验。这一K08奖项将支持他实现以下目标 培训目标：1)获得临床模型方面的专业知识，以解决PLWH中的自杀意念；2)获得 独立调查员级别的技能，通过以下方式制定和评估精神健康干预措施 临床试验研究；3)发展在资源有限的情况下领导转化性研究的能力；以及4) 熟练掌握远程保健治疗和适应远程保健提供的干预措施。为了支持这些 目标，Knettel博士建议成立一个由David Goldston博士领导的指导团队，David Goldston博士是 自杀预防领域；共同导师Blandina Mmbaga博士将指导翻译艾滋病毒研究方面的培训 共同导师Michael Relf博士是艾滋病毒护理参与临床试验方面的专家；以及共同导师 西尔维娅·卡亚博士是坦桑尼亚精神病学家，专门研究行为干预的适应性。专家 瑞安·肖博士和伊丽莎白·特纳博士在远程医疗和临床试验方面提供进一步的指导 生物统计学。将通过面对面的全面培训计划来实现培训目标 指导、课程、研讨会、实验室会议和国际研究站点的合作。这个 拟议的研究将包括目标1：确定远程保健干预的期望特征 坦桑尼亚临床背景下的自杀和艾滋病毒护理参与，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：在试点中测试远程保健模式 随机对照试验。鉴于有新的证据表明远程保健方法可以改善获得治疗的机会 并缩小健康差距，该干预措施具有支持NIMH战略目标的巨大潜力 解决精神健康并存问题，加强艾滋病毒护理连续体。拟议的研究还将 为Knettel博士的第一份R01提案提供初步数据，该提案将在K08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.