Designing adaptive implementation strategies for mental health care in persons living with HIV (DASH)

Washington University, Saint Louis MO

Investigators

Abstract

Depression and other mental health conditions are common in people with HIV and continue to compromise quality of life and impede achievement of optimal HIV care outcomes. Problem-solving therapy is a form of cognitive-behavioral therapy that has been shown to be efficacious at improving a range of mental health outcomes when used across a range settings, including rural settings in the United States. Where, how and when problem-solving therapy is best delivered remains an open and critical question to advancing the scale-up of this treatment— particularly in locations where resources are limited or there is high variation in patient, provider, or community wants, needs, and resources for mental health care. This proposal aims to address these issues by leveraging stakeholder-driven methods to develop an adaptive approach to problem-solving therapy delivery for people with HIV in low-resource settings in Missouri. Specifically, I aim to: 1) determine stakeholder preferences regarding the distinct features of problem-solving therapy delivery for people with HIV; 2) develop an adaptive mental health treatment delivery approach consisting of an initial low-intensity approach, followed by a more intensive approach for patients who do not respond; and 3) pilot test this adaptive approach among people entering HIV care in Missouri with clinically meaningful depressive symptoms. My overarching goal is to become an independently funded researcher who leads multi-disciplinary teams and uses innovative methods such as adaptive treatment delivery strategies to improve the mental and physical health of people with HIV in low-resource settings. This K01 award will build upon my strong foundation in advanced epidemiologic methods and applied experience conducting mental health research to address identified gaps in my training and expertise. In collaboration with my world-class mentorship team, I have designed an intensive 5-year training plan that incorporates didactic and other capacity-building activities (e.g., seminars, one-on-one mentoring meetings) with applied experience to achieve the following training goals: 1) Establish expertise developing qualitative interview guides and conducting qualitative thematic analyses; 2) gain a robust theoretical understanding of and expertise leading Implementation Mapping activities; and 3) develop expertise in the design, implementation, and evaluation of adaptive intervention delivery strategies. Ultimately, the proposed research and training will ensure my successful transition to independence as a faculty member in the School of Public Health at Washington University and provide the skills and preliminary data necessary to develop an R01 proposal to conduct a sequential multiple assignment randomized trial to evaluate adaptive problem-solving therapy delivery strategies for people with HIV in rural Missouri. Moreover, this work will fill urgent and widening gaps in access to mental health care for Missourians with HIV living in rural settings and directly address the NIMH’s third strategic goal to strive for prevention in care through tailoring existing interventions.