Streamlined treatment and evidence-based adolescent counseling and medication support (STREAMS) - STREAMS abstract interventions that use a combination approach-as recommended by unaids-to address…

The National Institute of Mental Health (NIMH) awarded a $1,057,586 Project Grant on September 19, 2025, to the Research Foundation of The City University of New York to implement and evaluate the Streamlined Treatment and Evidence-Based Adolescent Counseling and Medication Support (STREAMS) intervention. The project, extending through May 31, 2030, will deliver a combination mental health and HIV treatment adherence intervention targeting adolescents aged 15-19 living with HIV (ALWHIV) across 24 health clinics in Uganda's Greater Masaka region. The intervention integrates two evidence-based components: streamlined Interpersonal Psychotherapy Groups (IPT-G)—a condensed six-session counseling program tailored to the Ugandan context for addressing depression symptoms—and an adapted family-based economic empowerment and medication adherence counseling program designed specifically for youth experiencing depression-related symptoms.

This research project responds to a critical gap in mental health interventions for ALWHIV in low- and middle-income countries, addressing the intersection of HIV clinical outcomes and adolescent mental health as recommended by UNAIDS guidelines. The STREAMS evaluation will generate evidence on the feasibility, acceptability, and effectiveness of this combination approach, with anticipated deliverables including peer-reviewed publications, implementation findings, and validated intervention models that can inform HIV mental health service delivery across similar resource-limited settings. The award is funded under CFDA 93.242, the Mental Health Research Grants program, which supports rigorous research to advance understanding and treatment of mental health conditions.

Streamlined treatment and evidence-based adolescent counseling and medication support (STREAMS) - STREAMS abstract interventions that use a combination approach-as recommended by unaids-to address mental health in low- and middle-income countries (LMICS), are crucial to achieving the unaids 95-95-95 targets, yet few such evidence-based combination interventions currently exist for the 1.7 million adolescents living with HIV (ALWHIV) in africa. We propose streamlined treatment and evidence-based adolescent counseling and medication support (STREAMS) to evaluate a combination intervention comprising of streamlined interpersonal psychotherapy groups (IPT-G) tailored to adolescents (15-19 years) and streamlined family strengthening and treatment adherence counseling in rural uganda. In our pilot work, PI kreniske (K01MH122319) collaborated with strongminds and brown school's international center for child health and development (ICHAD) to demonstrate feasibility and acceptability of a streamlined text message based PHQ-9 screener to assess depression. Adolescents were successfully linked to strongminds 6-week IPT-G counseling and experienced a reduction in depressive symptoms. Strongminds IPT-G counseling is tailored to the ugandan context and has been reduced from a program based on 16 IPT-G sessions to the streamlined 6 sessions. To date, this approach has not been evaluated among ALWHIV. To address HIV counseling and adherence, we propose streamlining suubi+adherence (R01HD074949; PI ssewamala), a family-based combination intervention combining economic empowerment intervention with medication adherence counseling for ALWHIV in uganda that improves antiretroviral (art) treatment adherence but has not been examined specifically among youth experiencing symptoms of depression. STREAMS will be implemented across 24 ICHAD-affiliated HIV health clinics within the greater masaka region of uganda-a region heavily impacted by HIV compared to national averages. We will use a type I hybrid design 3-arm cluster-randomized trial to evaluate effectiveness at both reducing depressive symptoms and improving art adherence, with the secondary aim of characterizing the combined interventions' feasibility and acceptability comparing (1) streamlined IPT-G and streamlined suubi+adherence in combination, (2) streamlined IPT-G and SOC art counseling (3) SOC mental health and SOC art counseling. Randomized at the clinic level, adolescents will be consecutively sampled, and those who screen positive for depressive symptoms on the mobile phone administered PHQ-9 will be enrolled. Using consolidated framework for implementation research (CFIR) informed in-depth interviews and analysis, we will systematically assess barriers and facilitators to accessing mental health care and adhering to art across CFIR domains (e.g., individual characteristics, inner - healthcare settings) to inform scalable changes to care to support HIV treatment among ALWHIV in rural uganda. STREAMS examines if our mobile phone screening tool along with a combination of streamlined strongminds IPT-G and streamlined suubi+adherence art counseling, provides a low-cost, efficacious, and scalable approach for improving mental health and art adherence.