Evaluating the Long-Term Outcomes of a Mental Health Intervention in Tanzanian Youth Living with HIV

Abstract

Six percent of the world’s population of youth living with HIV (YLWH) reside in Tanzania. Despite scale up of antiretroviral therapy (ART), poor ART adherence contributes to AIDS related morbidity and mortality in YLWH. Reasons for poor adherence include mental health challenges, HIV-related stigma, and lack of psychosocial support. Sauti Ya Vijana (SYV), a group-based, lay counselor delivered, 10-session mental health intervention for Tanzanian youth living with HIV was developed. The objective of this study was to describe the mental health outcomes of SYV in youth living with HIV. This mixed-methods study enrolled 128 YLWH, aged 12-24, in Moshi, Tanzania to receive either the SYV intervention or treatment as usual. Youth in both arms completed structured questionnaires assessing their demographics, mental health and stigma symptoms, and self-reported ART adherence, at baseline, 6 months, 12 months, and 18 months study timepoints. A mixed effects linear regression model was used to analyze the change in stigma and mental health measures from baseline to the three follow-up timepoints. A subset of 10 youth who were randomized to the intervention arm completed semi-structured in-depth interviews at least one year after the intervention. Interviews were conducted in Kiswahili, and interview guide topics included participant description of history of depression symptoms, current challenges, recollection of specific SYV topics, and their experience during and after the SYV intervention. Interviews were transcribed and translated to English. Inductive thematic analysis using NVivo was used to analyze interview transcripts and identify common themes. One hundred and five youth were randomized; 58 to the intervention arm and 47 to the treatment as usual arm. Average age of participants at baseline was 17.8 years and 49% of enrolled participants were male. Majority of the youth (86%) randomized to the intervention arm attended at least 8 out of 10 SYV sessions. The study was not powered to statistically detect treatment effect, but youth enrolled in both study groups showed improvement in their mental health and internal stigma measures at all follow-up timepoints in comparison to baseline. Ten youth, 18-25 years of age, were interviewed. Seven of the ten participants were male, and 60% were responders. All participants attended at least eight of the 10 intervention sessions and all baseline, 6 months, and 18-month follow-up appointments. Participants all reported experiencing intermittent symptoms of depression such as feelings of sadness. Current challenges included difficult interpersonal relationships and taking ART on time. The most memorable SYV lessons were coping skills such as breathing exercises. Participants described how SYV helped them have “more confidence”, accept themselves, and incorporate positive coping skills such as relaxation (deep breathing) when they felt stressed.The findings provide evidence that providing a 10-session group based mental health intervention can have a long-term impact on the psychosocial outcomes of YLWH and can improve resilience in this population. Implementation of the SYV intervention into the routine HIV clinical care has promise to improve overall well-being of YLWH.