A new clinical trial is underway in Tanzania, seeking to address the mental health challenges faced by young people living with HIV (YPLWH). The trial, titled Sauti ya Vijana (SYV: The Voice of Youth), aims to evaluate the effectiveness of a peer-led, group-based mental health and life skills intervention for adolescents.

Conducted across four regions in Tanzania – Kilimanjaro, Morogoro, Mbeya, and Mwanza – the trial seeks to improve both viral suppression and mental health outcomes for YPLWH aged 10 to 24 years. Hundreds of participants are involved, with enrollment having started on March 1, 2023, and expected to conclude in December 2024.

Led by Ifakara Health Institute scientist Getrud Mollel, the trial also includes expertise from the Baylor College of Medicine Children Foundation of Tanzania, Kilimanjaro Christian Medical Centre (KCMC), Duke University Medical Center, Duke University, Sandford School of Public Policy, and the University of North Carolina at Chapel Hill.

Addressing challenges facing adolescents with HIV
“Young people living with HIV experience increased morbidity and mortality compared to all other age groups. Adolescence brings unique challenges related to sexual reproductive health, the elevated importance of peer groups, and often, emerging symptoms of emotional distress,” explained the scientists adding that, “Failure to address this unique life stage for YPLWH can lead to worse HIV and mental health outcomes.”

In Tanzania, adolescents living with HIV face several challenges such as stigma, difficulties in disclosing their HIV status, and a lack of social support. The SYV intervention directly addresses these issues through youth participatory methods to ensure that it resonates with the realities of those it seeks to help.

The SYV intervention approach
The SYV intervention will be delivered by trained peer group leaders (PGLs), who themselves live with HIV, ensuring that the program is relatable and impactful. These PGLs will receive intensive training to help them process their own experiences before supporting others. Additionally, the trial will rely heavily on social workers and trained nurses.

The intervention will include group-based sessions and individual sessions, where participants will discuss their experiences with HIV and set value-based goals. Caregivers or supportive adults will also be encouraged to join some group sessions to help create a supportive environment for the youth.

Evaluating the effectiveness of SYV 
Throughout the trial, scientists will evaluate several aspects including mental health, adverse childhood events, interpersonal violence, resilience, stigma, HIV knowledge, substance use, sexual relationships, ART adherence, and HIV RNA levels as well as assess the effectiveness of the intervention.

In addition, the trial will assess implementation outcomes, including acceptability, feasibility, and fidelity through attendance, intervention session notes, focus discussion groups, and qualitative interviews. A cost analysis will be conducted to assess the value for money of implementing the SYV program in Tanzania and inform policymakers about the feasibility of incorporating SYV into routine clinical care.

Inspiration and potential impact of SYV 
Inspired by successful peer-led programs in Zimbabwe and Rwanda, the SYV trial aims to improve HIV treatment and mental health outcomes for young people in Tanzania and beyond, despite challenges that remain in scaling these interventions and ensuring their sustainability.

As the trial progresses, it is expected to provide valuable insights that could influence future mental health interventions for adolescents with HIV.

“Few mental health interventions for YPLWH have demonstrated effectiveness. Results from this study will provide information about the effectiveness and implementation of a peer-led intervention for delivering a mental health and life skills intervention in low-income settings.”

“Despite the potential limitations, the SYV trial has tremendous potential to further improve HIV outcomes and the mental health trajectory for YPLWH.”

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