Results of a Pilot Randomized Controlled Trial of Ideas for Hope, a Brief Telehealth Intervention for Suicide Prevention and HIV Care Engagement Among People Living with HIV in Tanzania

Background: People living with HIV (PLWH) face elevated risk of mental health challenges, including suicide. In Tanzania, there is a critical shortage of mental health providers and few interventions to address suicide risk among PLWH.<br><br>Methods: The IDEAS for Hope intervention combines universal suicide screening in HIV care, adherence strategies, stigma reduction, and problem solving. We identified 60 PLWH experiencing suicidal ideation at two HIV clinics in Moshi, Tanzania and randomized them 1:1 to receive brief safety planning or the three-session telehealth intervention. Participants completed a three-month follow-up survey with mixed-methods assessments of feasibility, acceptability, and preliminary efficacy to reduce suicidal ideation and improve HIV care engagement. The trial is registered at clinicaltrials.gov (ID: NCT04696861).<br><br>Findings: Session attendance was high at 88% and intervention fidelity, quality, and counseling skills exceeded pre-established thresholds in 94% of rated sessions. Participant ratings of acceptability showed high satisfaction with the counselor and the helpfulness of the intervention to reduce suicide risk, attend HIV clinic appointments, take antiretroviral medication, increase knowledge about HIV, foster hope, and cope with HIV-related stigma. Participants in both trial arms achieved similar, near-total recovery in suicidal thoughts (Cramer’s V = .07, p = .617). Between-arm differences in HIV treatment adherence were non-significant but showed a strong effect size in favor of the intervention (Cramer’s V = .18, p = .760). In qualitative feedback, participants described enhanced coping, social support, and problem-solving for economic empowerment, which fostered a renewed sense of hope.<br><br>Interpretation: IDEAS for Hope is a feasible and acceptable intervention that dramatically reduced suicide risk and improved HIV care engagement in this cohort. A larger clinical trial will determine the comparative effectiveness of this intervention and will inform implementation strategies.<br><br>Trial Registration: The trial is registered at clinicaltrials.gov (ID: NCT04696861).<br><br>Funding: National Institute of Mental Health (K08MH124459) and the Duke Center for<br>AIDS Research, an NIH-funded program (P30AI064518).<br><br>Declaration of Interest: We declare no competing interests.<br><br>Ethical Approval: The Tanzanian National Institute for Medical Research and the Institutional Review Boards of Kilimanjaro Christian Medical Centre and the Duke University Health System.

Duke Scholars

Author Brandon Knettel School of Nursing

Author Elizabeth Louise Turner Biostatistics & Bioinformatics, Division of Biostatistics