A Group-based Mental Health Intervention for Youth Living with HIV in Northern Tanzania: Secondary Analyses of a Pilot Trial

Background: Youth Living with HIV (YLWH) face numerous psychosocial stressors that impact mental health and HIV outcomes. YLWH are vulnerable to poor HIV outcomes due to incomplete adherence to ART in the context of stigma, poverty, mental health challenges, and decreased hope for future. Few mental health interventions have been developed to improve HIV and mental health outcomes for YLWH.

Methods: Sauti ya Vijana (SYV; “The Voice of Youth”) is a group-based mental health and life skills intervention developed with YLWH to address the complex psychosocial and mental health needs described by Tanzanian YLWH during formative research. SYV sessions were based on existing evidence-based treatment models—including components of cognitive behavioral therapy, interpersonal psychotherapy, and motivational interviewing—designed to improve coping skills, resilience, social support, and hope for future as a pathway to improved adherence and virologic suppression. SYV was comprised of ten 90-minute group-based sessions (two that incorporated caregivers) and two individual sessions with group leaders (Figure 1). YLWH ages 12-24 years were recruited from two adolescent clinics in Moshi, Tanzania. At baseline, individuals were randomized to SYV or standard of care (SOC). Participants who were initially randomized to SOC, enrolled but were unavailable for randomization, or randomized to SYV but had incomplete attendance were invited to receive SYV in crossover waves. Outcomes included HIV-RNA, self-reported mental health measures (Patient Health Questionnaire-9, Strengths and Difficulties Questionnaire, and UCLA Post-Traumatic Stress Disorder Reaction Index), and self-reported HIV measures (stigma and adherence) that were measured at baseline, pre-intervention, and post-intervention time points. Participants were included in the final analysis if they had data for all three time points.

Results: 21 crossover participants (n=13 males; n=8 females) with a mean age of 20.5 years were included in the final analysis. At baseline, 15% of participants had symptoms of moderate to severe depression (PHQ9 >10), but none met this threshold pre- nor post-intervention (Table 1). Mean scores of all self-reported mental health questionnaires were in an asymptomatic range both pre- and post-intervention. Stigma scores and self-reported adherence remained essentially unchanged pre- to post-intervention. There was a 10% increase in participants who were virologically suppressed (HIV RNA < 400 copies/mL) post-intervention (81%, N=17) compared to pre-intervention (71%, N=15); participants with virologic failure pre-intervention who became virologically suppressed post-intervention were on the same protease-inhibitor based regimen (ATV/r or LPV/r).

Conclusion: Findings from this study reinforce the notion that mental wellbeing support is an important pathway to improved HIV outcomes for YLWH. Findings from this crossover group match the findings from the randomized pilot trial that found a 10% increase in virologic suppression pre- to post-intervention in the intervention arm compared to SOC, providing additional support that SYV holds promise to improve HIV outcomes for YLWH.