Identifying Means to Address Alcohol, Substance Use, and Mental Health Concerns to Enhance the HIV Care Continuum among Youth Living with HIV in Zimbabwe

Zimbabwe faces one of the most pronounced HIV epidemics in the world. Despite some recent HIV treatment-related successes across the country, Zimbabwean youth who are living with HIV continue to lag far behind their HIV+ adult counterparts with respect to key HIV treatment-related metrics; particularly the attainment of HIV viral suppression. Alcohol, substance use, and mental health concerns such as depression and anxiety may be hindering HIV treatment-related outcomes among Zimbabwean youth living with HIV. While this indicates the need to develop and integrate addictions and mental health interventions into the youth-focused HIV care continuum, the marked economic challenges currently faced by Zimbabwe suggest that such interventions will only be successful if they are designed to be delivered with minimal resources and with sustainability in mind. Recognizing this situation, consultation with stakeholders relevant to the HIV epidemic among Zimbabwean youth, including community members, HIV care providers, and health policy makers, will be imperative for guiding the development of these interventions. This planning grant therefore entails a series of stakeholder meetings to achieve the following objectives: 1) to discuss potentially acceptable and feasible interventions to address alcohol, substance use, and mental health concerns among HIV+ youth in three high HIV prevalence regions of Zimbabwe; 2) to discuss means through which addictions and mental health interventions could be integrated into youth-focused HIV care; and 3) to disseminate a report of key findings to stakeholders, and to develop a grant application involving an alcohol-, substance use-, and/or mental health-focused intervention tailored for HIV+ Zimbabwean youth. This work will bring to the forefront addictions and mental health concerns in relation to the HIV care cascade among Zimbabwean youth, and it will catalyze a collaboration aimed at improving HIV treatment outcomes among this group.

Dr. Paul Shuper is a Senior Scientist and Section Head of Community, Addiction and Mental Health Research and Evaluation (CARE) at IMHPR. In addition to his NIH/NIAAA- and CIHR-funded investigations in Toronto, Dr. Shuper has been conducting research in Sub-Saharan Africa since 2007. His work in this latter region focuses on improving HIV prevention- and treatment-related outcomes by targeting underlying addictions- and mental health-related concerns among key affected populations. For example, he was the PI of a recently-completed CIHR-funded initiative that involved collaborating with mining companies, mineworker unions, and national-level South African government representatives to identify potentially acceptable, feasible, and effective intervention approaches to address the disproportionately high levels of alcohol use, HIV, and TB among mineworkers in the country. He is also currently the PI of a CIHR-funded planning grant that focuses on identifying means to address the intersection of alcohol, substance use, and mental health concerns among Zimbabwean youth living with HIV. Efforts that target this specific population are especially crucial for HIV-focused efforts, as HIV+ adolescents and young adults in Zimbabwe demonstrate the lowest rates of HIV viral suppression in the country.

In recognition of his program of research and work within the region, Dr. Shuper was invited to deliver a plenary presentation on alcohol and HIV in Sub-Saharan Africa at the 2017 South African AIDS Conference. Of note is that he presented in the same session as Cyril Ramaphosa, then Deputy President, and now President, of South Africa. He has also been invited to multiple World Health Organization (WHO)/United Nations Development Programme (UNDP) regional meetings, where he has presented his research and has worked with country delegates to provide recommendations on integrated alcohol/HIV/TB programs and policies. Finally, Dr. Shuper has been a member of NIH/NIAAA’s working group on alcohol and HIV, and as part of this role, his recommended priorities for intervention research in the area of alcohol and HIV secondary prevention have just been published in NIAAA’s special issue of AIDS and Behavior. Dr. Shuper currently holds grants as a PI from NIH/NIAAA, CIHR, and the Ontario HIV Treatment Network (OHTN).