Abstract
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.