Results of a Pilot Randomized Controlled Trial of IDEAS for Hope: A Brief Telehealth Intervention for Suicide Prevention and HIV Care Engagement in Tanzania.

OBJECTIVE

People living with HIV (PLWH) face greatly elevated risk of mental health challenges, including suicide. In Tanzania, there is a critical shortage of providers and interventions to address suicide risk. The 3-session IDEAS for Hope intervention is delivered by telehealth, combining universal suicide screening in HIV care, adherence strategies, HIV-related stigma reduction, and problem solving.

METHODS

We identified 60 PLWH experiencing suicidal ideation at 2 HIV clinics in Kilimanjaro, Tanzania, and randomized them 1:1 to receive an evidence-based safety planning intervention or IDEAS for Hope. Participants completed surveys at baseline and 3-month follow-up with mixed-methods assessments of feasibility, acceptability, and preliminary efficacy to reduce suicidal ideation and improve HIV care engagement.

RESULTS

Session attendance was high at 88% and intervention fidelity, quality, and counseling skills exceeded pre-established thresholds in 94% of sessions. Participants were very satisfied with the counselors and helpfulness of the intervention to reduce suicide risk and improve care engagement. Participants in both trial arms achieved near-total recovery in suicidal thoughts (Cramer V = 0.07, P = 0.617). Between-arm differences in HIV treatment adherence were nonsignificant but showed moderate effects in favor of the intervention (Cramer V = 0.18, P = 0.760). In qualitative feedback, participants described improvements in coping, social support, and problem solving for economic empowerment, which fostered a renewed sense of hope.

CONCLUSIONS

IDEAS for Hope is a feasible and acceptable intervention that reduced suicide risk and improved HIV care engagement in this cohort. A larger clinical trial will be powered to determine comparative effectiveness, evaluate mechanisms of change, and inform future implementation strategies.