Development of a brief telehealth-delivered counseling intervention to reduce suicide risk and improve HIV care engagement in Kilimanjaro, Tanzania

Abstract

Death by suicide is common among people living with HIV (PLWH) in Tanzania, and is strongly influenced by HIV stigma, lack of social support, and HIV-associated stress. Screening and intervention strategies for reducing suicidality, however, are not incorporated into standard HIV care. This study describes the development of a brief, nurse-led telehealth counseling intervention to address suicidal IDeation through HIV Education and counseling, advancing treatment Adherence, and reducing Stigma for renewed Hope (IDEAS for Hope) among PLWH in Tanzania. The three intervention sessions are based on Four Pillars, supported by personal values, to motivate change and build hope for the future: 1) Living healthy with HIV; 2) Managing HIV stigma; 3) Seeking social support; and 4) Active problem-solving to address social determinants of health. The IDEAS for Hope intervention integrates universal suicide screening into routine HIV care; PLWH with recent suicidal ideation are connected by video call to the first IDEAS for Hope session, with two additional sessions offered at two-week intervals. The intervention model is informed by Motivational Interviewing-enhanced safety planning (MI-SafeCope), cognitive-behavioral therapy, and problem-solving therapy frameworks, which are combined to facilitate HIV care engagement, address key contributors to suicidality among PLWH, and build hope for the future.