1085-Tanzania-Addressing mental health co-morbidities to promote HIV pre-exposure prophylaxis (PrEP) among women who use drugs in Tanzania

Women who use drugs (WWUD), specifically heroin, shoulder a disproportionate burden of the HIV epidemic in Tanzania. Despite advances in HIV prevention biomedical interventions, including pre-exposure prophylaxis (PrEP), PrEP uptake has been slow in Tanzania. Mental disorders, including depression, anxiety, and post-traumatic stress disorder, are high among WWUD and are known barriers to HIV prevention behaviors, including PrEP engagement. Inattention to the high prevalence of mental health problems in WWUD, is likely to undermine efforts to increase the use of HIV prevention strategies, including PrEP, among this highly vulnerable, yet understudied population. Motivational interviewing (MI) and cognitive-behavioral therapy (CBT) are evidence-based interventions that have been successfully delivered by paraprofessionals, both globally and in Tanzania, for a range of health conditions, including substance use disorders and mental disorders, and to improve uptake and adherence of HIV prevention strategies. The Common Elements Treatment Approach (CETA) is a transdiagnostic, CBT-based intervention developed for use in low- and middle-income countries for delivery by lay counselors with no or limited previous mental health training. The goal of this study is to adapt MI for PrEP engagement (MI-PrEP) and a combined CETA and MI-PrEP interventions (CETA+MI-PrEP) for delivery by paraprofessionals in Dar es Salaam, Tanzania, to optimize PrEP engagement among WWUD. The specific aims of this study are to: (1) identify barriers and motivators to PrEP engagement, and the types of paraprofessionals who could most effectively deliver the MI-PrEP and CETA+MI-PrEP interventions using in-depth interviews and focus groups with WWUD, peer- and non-peer community health workers, lay counselors, and mental health specialists, (2) systematically adapt MI-PrEP and CETA for WWUD with co-occurring mental disorders in Tanzania using the ADAPT-ITT model, and (3) assess the feasibility, fidelity, and preliminary efficacy of the MI-PrEP and CETA+MI-PrEP interventions in a three-arm pilot feasibility trial with 120 WWUD with co-occurring symptoms of mental disorders. 

Through this field placement the student will support aim 3 of the study, the pilot trial. The student will support the Hopkins and Tanzania-based team with on-the-ground study activities, including coordination of study activities and meeting with the study’s community and study advisory boards, data monitoring, data quality assurance, data analysis, and other administrative and research duties in support of the study. The student will work with Dr. Haneefa Saleem from JHSPH (PI) and Dr. Samuel Likindikoki at Muhimbili University of Health and Allied Sciences (Co-PI) during the placement.

office based at a university. The student will work out of the project office on the campus of the Muhimbili University of Health and Allied Sciences. The office will be shared by other members of the research team, including the research coordinator, intervention coordinator, and local research assistants. The student may be asked to accompany local research assistants as they conduct field data collection in local communities throughout the city. 

is interested in HIV prevention, mental health, and issues around health equity for marginalized groups, particularly among people who use drugs. This placement requires flexibility and cultural agility.

The ideal candidate will have some foundational knowledge of and experience with qualitative, survey, and implementation research. Candidates should have experience working collaboratively on teams, and engaging across cultural contexts. Project management/coordination skills would be an advantage.
Other preferred skills include:
•        Experience living and/or working abroad, preferably in Africa 
•        Familiarity with issues surrounding HIV and substance use 
•        Strong writing skills (e.g. peer-reviewed publications, program reports)
•        Detail-oriented disposition

Name: Haneefa Saleem, haneefa.saleem@jhu.edu 

I would describe my communication and mentorship styles as... 

transparent and supportive. I am committed to my students’ growth and development. I see my role as mentor as supporting students to identify and meet their professional goals and objectives. I make a concerted effort to provide students with opportunities to explore new ideas/topics and challenge them to think critically about the world. I prioritize responding in a timely manner to my students and expect the same from my students.

A complementary student would have a working style and mentorship expectations that are..

aligned with mine and the study team's. I expect the student to be intellectually curious and to have a strong, independent work ethic. The student must show respect to their colleagues but also to the beneficiaries of the research and programs. The student should feel comfortable with asking questions when assignments are unclear. The complementary student would provide regular updates on project progress to me and other investigators on the project and be transparent about challenges. The student should feel free to take initiatives, knowing that the team will support them.

Estimated costs:

Housing: $500/month; Food: $150/month; Local transportation (buses): $50/month; Internet: $50/month SIM card; Miscellaneous: $50/month; TOTAL: $800/month

Additional support from PI:

A stipend may be available.