Adaptation and optimization of the friendship bench mental health intervention for adolescent girls and young women in south african prep delivery settings

This $233,335 National Institute of Mental Health project grant supports the adaptation and optimization of the Friendship Bench mental health intervention for adolescent girls and young women in South African HIV pre-exposure prophylaxis (PrEP) delivery settings. The University of Washington will receive funding to support Dr. Jennifer Velloza's development as an independent researcher focused on improving mental health intervention delivery integrated with HIV prevention services for young women. Over a five-year period, Dr. Velloza will receive training in human-centered design and implementation science to build her capacity to lead a trial testing and optimizing a mental health intervention for South African adolescent girls and young women in PrEP clinics. The goals of the trial are to adapt intervention content, evaluate effectiveness on mental health and PrEP adherence outcomes, and identify implementation strategies for integrating the Friendship Bench problem-solving therapy into PrEP delivery consistent with the National Institute of Mental Health's mission of transforming mental health research and care.

Abstract

The goal of the proposed K99/R00 award is to support DR. Jennifer velloza's development into an independent HIV and mental health researcher, with a focus on improving delivery of mental health interventions integrated with HIV prevention services for young women. DR. Velloza is an epidemiologist and postdoctoral fellow at the university of washington. This proposal outlines a 5-year training and research plan to build her capacity with formal training in human-centered design and implementation science. Training plan: to ensure transition to independence, DR. Velloza has assembled a multidisciplinary team of mentors and advisors with expertise in human-centered design, implementation science, and prep and mental health service delivery for south african adolescent girls and young women (AGYW). They have crafted a robust training plan with meetings and relevant coursework. The training goals for the K99 are to: 1) gain proficiency in human-centered design for intervention adaptation; 2) apply implementation science tools to identify implementation strategies for integrating a mental health intervention in prep delivery; and 3) transition to independence by leading a trial to test and optimize a mental health intervention for south african AGYW in prep settings. These goals build on her prior experience and training and support her long-term career goals. Research plan: african AGYW face high rates of HIV and common mental disorders. Prep is a highly effective HIV prevention approach which is being scaled up in south africa. However, symptoms of common mental disorders are significant barriers to prep use and the south african department of health is placing increasing emphasis on layered approaches to prep delivery for AGYW. Effective mental health treatment, such as problem-solving therapy (PST), has the potential to be integrated with prep delivery to address mental health challenges and modifiable barriers to prep use and improve prep adherence for AGYW. The friendship bench is a promising evidence-based PST intervention option for AGYW in prep settings given that IT was developed for delivery in busy HIV clinics, is currently being scaled-up in south africa, and preliminary data suggests IT can be adapted to improve HIV treatment adherence among african women. Research is needed to adapt intervention content, evaluate effectiveness on mental health and prep adherence outcomes, and identify implementation strategies for AGYW in prep delivery settings. The overall goal of this proposal is to adapt, test, and optimize the friendship bench for african AGYW in prep delivery. The specific aims are to: 1) identify content for a mental health intervention and barriers to implementation in prep clinics; 2) design and pilot youth friendship bench SA content and implementation strategies; 3) conduct a hybrid type II trial to assess preliminary effectiveness of youth friendship bench SA on prep adherence while optimizing implementation for cost constraints in prep delivery; and 4) identify themes around intervention experiences. These aims correspond with DR. Velloza's training goals and she will emerge as an independent scientist contributing to high priority issues around mental health and HIV prevention service delivery.