The proposed K08 Career Development Award will provide Dr. 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 3-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. Dr. 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, Dr. Knettel proposes a mentoring team led by Dr. David Goldston, a leading clinician-scientist in the area of suicide prevention; Co-Mentor Dr. Blandina Mmbaga will guide training in translational HIV research in Tanzania; Co-Mentor Dr. Michael Relf is an expert in clinical trials for HIV care engagement; and Co-Mentor Dr. Sylvia Kaaya is a Tanzanian psychiatrist specializing in the adaptation of behavioral interventions. Expert consultants Drs. Ryan Shaw 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, coursework, 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 Dr. Knettel's first R01 proposal, to be submitted in the final year of this K08 award.

Suicidal ideation is strikingly common among people living with HIV worldwide, leading to higher burden of disease for both mental illness and HIV, poor HIV care engagement, increased transmission risk, and loss of life. In this K08 Career Development Award, Dr. Knettel proposes to develop and pilot test a 3-session, nurse- delivered telehealth counseling intervention to reduce suicidality and improve HIV care engagement among people living with HIV in Tanzania. By completing the proposed research and training plans, Dr. Knettel seeks to create a scalable intervention model to address a critical public health challenge, while gaining the needed skills to transition to independence as an academic researcher.