Developing and piloting a multilevel intervention to address psychosocial and structural syndemics in people with HIV in south africa - background: south africa (SA) has a generalized HIV epidemic,…

Developing and piloting a multilevel intervention to address psychosocial and structural syndemics in people with HIV in south africa - background: south africa (SA) has a generalized HIV epidemic, and the highest HIV prevalence rate (19%). Psychosocial (e.g., depression, post-traumatic stress) and structural problems (e.g., food insecurity) are associated with worse antiretroviral therapy (art) adherence and higher viral load. Depression, post-traumatic stress, and food insecurity are also highly comorbid and are thought to interact synergistically to confer greater risk for worse HIV outcomes (i.e., syndemic problems). The goal of this proposal is to obtain the necessary training and support needed to develop and test a multilevel intervention to address syndemic problems and improve art adherence (CBT-SA). Candidate: i am a clinical psychologist with specialized training in behavioral medicine and quantitative psychology, and currently a post-doctoral fellow at massachusetts general hospital and harvard medical school. This 5-year career development award will provide the mentorship, training, and experience needed to become an NIH-funded independent investigator studying the effects of syndemic problems on HIV and developing and testing interventions to address these syndemic effects in resource-limited settings globally. Mentoring: DR. Conall o'cleirigh will serve as my primary US-based mentor given his expertise in trauma, depression and HIV in resource-limited settings. DR. John joska will be my primary SA-based mentor due to his experience with the presentation of depression and trauma, and developing interventions in SA. My CO-mentors will be DR. Christina psaros given her expertise in conducting qualitative research and DR. Jessica magidson because of her experience in implementation science. My scientific advisory board is comprised of experts from SA and the US: DR. Ashraf kagee (intersection of structural and psychosocial problems), DR. Steven safren (intervention development), and DR. Daniel feaster (biostatistics), with consultation from DR. Julian may (addressing food insecurity) and DR. Lenny naidoo (government). Training: i propose to obtain training in qualitative methods for conceptual framework development and intervention evaluation, intervention development and the NIH stage model, and implementation science theory and frameworks. These training goals will provide the necessary knowledge to develop, test, and eventually implement interventions to address syndemic problems and HIV treatment outcomes. Research: the proposed specific aims are to: 1) explore the complex interrelationships between food insecurity, depression, and post-traumatic stress, as they relate to engagement in HIV care, and explore attitudes to potential intervention components; 2) develop a multilevel intervention to address syndemic problems and improve adherence (CBT-SA) and conduct an iterative proof-of-concept pilot trial use syndemic theory; 3A) assess the feasibility and acceptability of CBT-SA in a pilot RCT; and 3B) identify barriers and facilitators of CBT-SA engagement among PWH and uptake among care providers and other key local partners to inform a future hybrid effectiveness/implementation R01 trial. If successful, this intervention would be further tested for effectiveness and implementation in a future application.