# Addressing mental health and medication adherence among MSM in South Africa

> **NIH NIH R34** · EMORY UNIVERSITY · 2024 · $198,531

## Abstract

PROJECT SUMMARY
In this R34 application (PAR-23-060, Formative and Pilot Intervention Research to Optimize HIV Prevention
and Care Continuum Outcomes), we propose to develop and pilot test an integrated intervention that
addresses the dual and interconnected priorities of mental health and HIV medication adherence. This
research responds to the global public health calls to enhance HIV intervention science for MSM who
experience growing HIV prevalence and the highest HIV incidence rates in sub-Saharan Africa. Despite South
Africa national campaigns to provide HIV prevention medication (daily PrEP) and treatment medication (ART)
to this population, growing evidence points to suboptimal adherence to these efficacious biomedical
interventions among MSM communities, and underscores a need for medication adherence programs targeting
this group. Common mental health problems such as depression are also prevalent among MSM, and
untreated mental health problems are strongly associated with poor adherence to PrEP and ART. There are
emerging indications that interventions providing targeted and integrated mental health treatment and
adherence support can impact both outcomes in general populations in sub-Saharan Africa, but there is need
to develop and evaluate MSM-focused programs. The proposed intervention, currently titled WeCare, will be
based on principles of problem-solving therapy, minority stress theory, and a status-neutral approach which
includes MSM in mental health and adherence interventions regardless of HIV status in order to optimize reach
and impact, minimize stigma, and enhance support in this community. We will use a three-phase research
approach to address our specific aims. First, we will conduct formative qualitative research to develop an
intervention approach targeting mental health and HIV medication adherence support, and that is responsive to
the social context and minority stressors in this key population. Second, we will conduct an open pilot to refine
and finalize the intervention manual and research protocol. Third, we will conduct a randomized pilot trial to
test the intervention compared to an enhanced standard of care control. Participants in the pilot trial will be
assessed at baseline, 3-months, and 6-months post-enrollment. We will assess intervention effects on primary
outcomes including a mental health, biologically confirmed medication adherence; exploratory secondary
outcomes including self-report medication adherence, PrEP persistence, and interest in long-acting PrEP and
ART; exploratory theoretical mediators including multidimensional stigma (internalized, anticipated, enacted,
concealment), social support, and positive identity. We will also conduct qualitive assessment to examine
intervention characteristics that can optimize further implementation and scalability. The findings from this
study will provide the necessary groundwork to examine the efficacy of this combined mental health and
medication adherence i...

## Key facts

- **NIH application ID:** 10925541
- **Project number:** 1R34MH135806-01A1
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** DON OPERARIO
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $198,531
- **Award type:** 1
- **Project period:** 2024-08-19 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10925541

## Citation

> US National Institutes of Health, RePORTER application 10925541, Addressing mental health and medication adherence among MSM in South Africa (1R34MH135806-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10925541. Licensed CC0.

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