Integrating SYV within HIV clinical care for youth living with HIV in Tanzania

Youth living with HIV (YLWH) experience mental health (MH) challenges that compromise their HIV care. Though the MH gap is well described, integrated MH service delivery to YLWH is rare, both in the United States (U.S.), and lower resourced settings. MH professionals are rarely available in HIV clinics and few youth are willing to engage in outside care. Interventions tailored to the needs of this population are scarce and critically needed. Streamlining the Sauti ya Vijana (SYV, The Voice of Youth) intervention offers a way to bridge the MH gap. SYV is a peer-led, group-based treatment designed with and for YLWH to address their self-reported MH challenges. SYV incorporates components of evidence-based psychotherapeutic models to address the needs youth described in formative interviews. Preliminary data estimated effects towards improved MH, antiretroviral therapy adherence, and a 10% greater increase in viral suppression in the intervention arm compared to standard of care. Our prior research shows similar levels of depressive symptoms among U.S. YLWH and a desire to bring this model to the U.S. context through reciprocal innovation (Dow, Pediatrics 2025). The central hypothesis is that the new integrated “i" SYV will be acceptable, feasible, and effective to improve virologic suppression and improve retention in care. The mechanism of change is that improved MH leads to better medication adherence, viral suppression, and care engagement. The rationale is twofold: 1) MH screening is being initiated in HIV clinical visits, but the MH treatment gap persists; 2) the iSYV stepped-care package could be an effective approach to support integrated MH care for YLWH. Evidence generated in the African context can be obtained more cost-efficiently and applied to inform solutions for American YLWH. The central hypothesis will be tested in a hybrid type-2 effectiveness-implementation trial. The first aim will leverage the Fit to Context Framework, using an iterative Designing for Dissemination and Sustainability approach. SYV peer-group leaders (PYL) with extensive experience delivering SYV will co-design the new iSYV package. The iSYV in-person sessions will be delivered by trained PYLs and be aligned to the Tanzanian differentiated care model: stable youth (those fully suppressed) attend clinic every 6 months; and unstable youth (those with HIV RNA > 50 copies/mL) attend enhanced adherence counseling monthly, similar to U.S. guidelines. Youth with symptoms of MH difficulties on screening (PHQ9-depression, GAD7-anxiety, Trauma-related stress) will join the unstable group. To support engagement between visits, iSYV will explore use of a mHealth gamification strategy. The second aim includes a pilot and a four-arm cluster randomized trial. A large U.S. based implementing partner, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will support testing the iSYV care package. The third aim will evaluate implementation determinants and outcomes, including acceptability, feasibility, fidelity, and cost informed by the Consolidated Framework for Implementation Research. The proposal is significant because it is expected to help address the MH gap for YLWH with implications for HIV care in Tanzania as well as the U.S. Project Number: 1R01MH140399-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Dorothy Dow (+1 co-PI) | Institution: DUKE UNIVERSITY, DURHAM, NC | Award Amount: $211,504 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 SCIL-Y (56)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11168029