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Principal Investigator: Brandon A Knettel
Organization: DUKE UNIVERSITY
Fiscal Year: 2024
Award: $166,317
Funding agency: National Institute of Mental Health
The proposed K08 Career Development Award will provide Dr. Knettel with the training and mentorship to
become an independent clinical scientist focused on developing novel, yet scalable mental health interventions
in resource-limited settings. The objective of the proposed research is to assess the feasibility and acceptability
of a 3-session, nurse-delivered telehealth intervention to reduce suicidality and improve HIV care engagement
among adults living with HIV in the Kilimanjaro Region of Tanzania. Suicide is a leading cause of death among
people living with HIV (PLWH) worldwide and mental health disorders are key contributors to poor HIV care
engagement, lower quality of life, higher transmission risk, and increased mortality among PLWH. Conversely,
connecting PLWH with targeted mental health support improves these critical health outcomes. Telehealth
counseling represents a cost-effective, innovative approach to mental health treatment in low-resource settings
such as Tanzania, with the potential to `leapfrog' less efficient approaches and expediently extend services. Dr.
Knettel is a Licensed Psychologist with a strong background as a clinician and researcher in mental health and
HIV, including extensive experience in Tanzania. This K08 award will support him to achieve the following
training objectives: 1) acquire expertise in clinical models to address suicidal ideation among PLWH; 2) obtain
independent investigator-level skills in the development and evaluation of mental health interventions via
clinical trial research; 3) develop the capacity to lead translational research in resource-limited settings; and 4)
gain proficiency in telehealth treatment and adaptation of interventions for telehealth delivery. To support these
objectives, Dr. Knettel proposes a mentoring team led by Dr. David Goldston, a leading clinician-scientist in the
area of suicide prevention; Co-Mentor Dr. Blandina Mmbaga will guide training in translational HIV research in
Tanzania; Co-Mentor Dr. Michael Relf is an expert in clinical trials for HIV care engagement; and Co-Mentor
Dr. Sylvia Kaaya is a Tanzanian psychiatrist specializing in the adaptation of behavioral interventions. Expert
consultants Drs. Ryan Shaw and Elizabeth Turner offer further mentorship in telehealth and clinical trial
biostatistics. Training objectives will be met through a comprehensive training plan involving in-person
mentorship, coursework, seminars, lab meetings, and collaboration at the international research site. The
proposed study will include Aim 1: Identifying the desired characteristics of a telehealth intervention for
suicidality and HIV care engagement in the Tanzanian clinical context, Aim 2: Refining intervention content
with support from a local study advisory board in Tanzania, and Aim 3: Testing the telehealth model in a pilot
randomized control trial. Given emerging evidence for telehealth approaches to improve access to treatment
and reduce health disparities, the intervention has great potential to support NIMH strategic objectives to
address mental health comorbidities and strengthen the HIV care continuum. The proposed study will also
provide preliminary data for Dr. Knettel's first R01 proposal, to be submitted in the final year of this K08 award.
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