Kudos to Brandon Knettel, assistant professor, and his entire team for the submission of his NIH K08 application entitled: "Telehealth to Reduce Suicidality and Improve HIV Care Engagement in Tanzania." This proposal requests funding for a four year period with a start date of July 1, 2021.

The proposed K08 Career Development Award will provide Knettel with the training and mentorship to become an independent clinical scientist focused on developing novel yet scalable mental health interventions in resource-limited settings. The objective of the proposed research is to assess the feasibility and acceptability of a three-session, nurse-delivered telehealth intervention to reduce suicidality and improve HIV care engagement among adults living with HIV in the Kilimanjaro Region of Tanzania.

Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, and mental health disorders are key contributors to poor HIV care engagement, lower quality of life, higher transmission risk and increased mortality among PLWH. Conversely, connecting PLWH with targeted mental health support improves these critical health outcomes. Telehealth counseling represents a cost-effective, innovative approach to mental health treatment in low-resource settings such as Tanzania, with the potential to ‘leapfrog’ less efficient approaches and expediently extend services.

Knettel is a licensed psychologist with a strong background as a clinician and researcher in mental health and HIV, including extensive experience in Tanzania. This K08 award will support him to achieve the following training objectives: 1) acquire expertise in clinical models to address suicidal ideation among PLWH; 2) obtain independent investigator-level skills in the development and evaluation of mental health interventions via clinical trial research; 3) develop the capacity to lead translational research in resource-limited settings; and 4) gain proficiency in telehealth treatment and adaptation of interventions for telehealth delivery. To support these objectives, Knettel proposes a mentoring team led by David Goldston, a leading clinician-scientist in the area of suicide prevention; co-mentor Blandina Mmbaga to guide training in translational HIV research in Tanzania; co-mentor Michael Relf, associate dean for global and community health affairs, who is an expert in clinical trials for HIV care engagement; and co-mentor Sylvia Kaaya, a Tanzanian psychiatrist specializing in the adaptation of behavioral interventions. Expert consultants Ryan Shaw, associate professor, and Elizabeth Turner offer further mentorship in telehealth and clinical trial biostatistics.

Training objectives will be met through a comprehensive training plan involving in-person mentorship, course work, seminars, lab meetings and collaboration at the international research site. The proposed study will include Aim 1: Identifying the desired characteristics of a telehealth intervention for suicidality and HIV care engagement in the Tanzanian clinical context, Aim 2: Refining intervention content with support from a local study advisory board in Tanzania, and Aim 3: Testing the telehealth model in a pilot randomized control trial. Given emerging evidence for telehealth approaches to improve access to treatment and reduce health disparities, the intervention has great potential to support NIMH strategic objectives to address mental health comorbidities and strengthen the HIV care continuum. The proposed study will also provide preliminary data for Knettel’s first R01 proposal to be submitted in the final year of this K08 award.