New York, NY | September 30, 2025 – In an ambitious step toward addressing the intertwined challenges of mental health and HIV treatment adherence in adolescents, the National Institutes of Health (NIH) has awarded a grant exceeding five million dollars to Dr. Philip Kreniske, Assistant Professor at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH). This funding supports a pioneering research initiative focused on improving health outcomes in rural Uganda, where adolescents living with HIV face significant barriers to effective care.
The study, entitled Streamlined Treatment and Evidence-based Adolescent counseling and Medication Support (STREAMS), is designed to confront the multidimensional health issues encountered by young individuals grappling with both HIV and depression. Adolescents living with HIV worldwide, and especially in low- and middle-income countries, experience complex challenges that jeopardize their mental well-being and undermine their adherence to antiretroviral therapy (ART). The prevalence of mental health disorders, particularly depression, among these adolescents significantly contributes to poor medication adherence, risking viral rebound and increased transmission.
Sub-Saharan Africa bears the brunt of this crisis, being home to approximately 1.7 million adolescents living with HIV. Despite the scale of the epidemic in this region, there remains a stark paucity of evidence-based mental health interventions tailored for youth. The STREAMS project aims to fill this critical gap by integrating mental health support directly into routine HIV care settings, leveraging a novel combination of technology and evidence-based therapeutic techniques adapted for the local context.
Implementation will occur across 24 HIV clinics affiliated with the International Center for Child Health and Development (ICHAD) in Uganda’s Masaka region. Employing a rigorous cluster-randomized trial methodology, the study will not only evaluate the program’s efficacy in mitigating depressive symptoms but will also rigorously assess its impact on improving adherence to antiretroviral medications. The design of this trial will allow researchers to capture nuanced data on contextual barriers and facilitators influencing both mental health and treatment outcomes.
At the core of the STREAMS intervention is a sophisticated, yet accessible, mobile health platform that enables mental health screening through smartphones or tablets. This platform facilitates timely identification of depression symptoms and supports delivery of evidence-based counseling. By effectively melding mental health, economic empowerment strategies, and medication adherence support into a cohesive intervention, the program addresses the multifaceted social determinants that undermine adolescent health in this context.
Dr. Kreniske underscores the novelty of STREAMS by stating, “The innovation lies in fusing well-validated HIV treatment advancements with culturally adapted, scalable mental health solutions—from decades of global biomedical progress to grassroots psychological care models refined in Uganda.” The integration of these elements aims to forge a comprehensive system that holistically supports young people’s health in real-world clinical environments.
The project also promises broader implications beyond HIV care. By pioneering implementation science approaches in consideration of feasibility and scalability from the outset, STREAMS may serve as a blueprint for integrating mental health interventions into diverse healthcare settings worldwide. The insights gained could inform global strategies targeting adolescent mental health in resource-limited environments, where service delivery frequently falls short of clinical needs.
Streamlined delivery benefits from collaborations with leading experts: Dr. Kreniske teams up with Dr. Proscovia Nabunya from Washington University, as well as CUNY SPH faculty members Drs. Chloe Teasdale and Sasha Fleary. Partnerships extend to investigators from New York University’s Silver School of Social Work and StrongMinds, a nonprofit organization recognized for delivering culturally relevant, evidence-based mental health services in underserved populations.
The trial’s outcomes will also provide vital evidence to guide policymakers, clinicians, and implementers on effective models for co-managing HIV and depression among adolescents. By advancing the science of integrated care, STREAMS addresses a key driver of poor health outcomes in sub-Saharan Africa’s large population of young people living with HIV.
“Testing these interventions in real-world service delivery settings is essential,” emphasizes CUNY SPH Distinguished Professor Denis Nash and executive director of the CUNY Institute for Implementation Science in Population Health (ISPH). “Our goal is not only to demonstrate effectiveness but also to ensure that these programs can be practically implemented at scale.”
This research benefits from the combined support of the National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The expertise and funding backing this initiative speak to the urgency and potential transformative impact of addressing mental health as an integral component of HIV care in youth.
By centering the STREAMS study on leveraging technology to streamline mental health screening and support, the initiative taps into the growing field of mobile health interventions. Such approaches offer promising scalability and cost-effectiveness vital in resource-limited settings, where traditional mental healthcare infrastructure is often limited or nonexistent.
Ultimately, through its ambitious, multidimensional approach, the STREAMS project represents a significant advance in global adolescent health, promising not only to improve lives in Uganda but to contribute essential knowledge for international efforts combating HIV and mental illness among young people.
Subject of Research: Improving mental health and antiretroviral treatment adherence among adolescents living with HIV in rural Uganda through integrated, technology-supported interventions.
Article Title: STREAMS Study Targets Mental Health and HIV Treatment Adherence in Ugandan Adolescents
News Publication Date: September 30, 2025
Web References:
– STREAMS Project: https://cunyisph.org/projects/streamlined-treatment-and-evidence-based-adolescent-counseling-and-medication-support-streams/
– NIH Awards to Dr. Philip Kreniske: https://sph.cuny.edu/about/people/faculty/philip-kreniske/
– CUNY Graduate School of Public Health and Health Policy: https://sph.cuny.edu/
– CUNY Institute for Implementation Science in Population Health: http://cunyisph.org
Image Credits: Courtesy of Assistant Professor Philip Kreniske
Keywords: Public health; Acquired immune deficiency syndrome; Human immunodeficiency virus; Adolescents; Young people; Mental health
