PROJECT SUMMARY Globally, gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV and common mental illnesses, including depression and anxiety. The mental health of GBMSM is directly affected by chronic exposure to sexual minority stressors, those that uniquely impact sexual minority individuals via prejudice events, such as enacted stigma and violence, as well as anticipated and internalized stigma and concealment of one’s sexual orientation. Behavioral interventions that address the multiple mental and sexual health problems caused by chronic exposure to sexual minority stress among GBMSM are urgently needed. The goal of this Career Development Award is to expand the candidate’s skillset and prepare him to conduct independent research on scalable behavioral interventions that integrate mental health and HIV services for sexual minority individuals in low- and middle-income countries (LMIC). Through a combination of didactic and applied training and mentorship from leading experts, the candidate will develop expertise in 1) the systematic adaptation of evidence-based interventions (EBI); 2) implementation science tools for identifying and evaluating implementation strategies; 3) theory and analysis of mechanisms of change for mental health interventions; and 4) leading culturally appropriate intervention research in LMIC. The candidate will apply the knowledge and skills gained through this training to conduct a pilot randomized control trial (RCT) in collaboration with Colectivo Amigos contra el SIDA (CAS), a GBMSM-serving community clinic in Guatemala City with whom he has extensively collaborated. Specifically, the candidate will adapt the ESTEEM (Effective Skills to Empower Effective Men) intervention to target pre-exposure prophylaxis (PrEP) uptake for the Guatemalan context and to identify implementation strategies (Aim 1). ESTEEM is a skills-building Cognitive Behavioral Therapy (CBT) intervention that was designed to reduce GBMSM’s co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health; it is effective at improving mental health and HIV-related behaviors among GBMSM in the US and China. He will then pilot the adapted intervention with 80 GBMSM to assess preliminary effectiveness on depression, anxiety, and PrEP uptake, and explore mechanisms of change (Aim 2). Finally, he will assess acceptability, feasibility, and fidelity of the adapted intervention and implementation strategies for future scale-up in other community clinic settings. Findings from this research will inform the development of an R01 proposal for a hybrid type 1 implementation- effectiveness trial to examine effectiveness and implementation sustainability of the scaled-up, adapted intervention. Together, the training, research, and collaborations outlined in the award will support the testing of a scalable mental health intervention with t...