Meet the CIPHER grantees

Merrian Brooks

Year awarded: 2020
Institution: Botswana UPenn Partnership, Children’s Hospital of Philadelphia
Research site: Botswana
Primary mentor: Elizabeth Lowenthal, Children’s Hospital of Philadelphia

Merrian Brooks is an adolescent medicine specialist physician and researcher at the Children’s Hospital of Philadelphia and the Botswana University of Pennsylvania Partnership. She co-leads a study exploring lay counsellor-based interventions to meet the mental health needs of adolescents living with and vulnerable to HIV.

“Young people living with HIV struggle to receive adequate mental healthcare, and the burden of HIV- and mental health-related stigma are compounded. This CIPHER project investigates how we can use non-clinical and other patient-centred approaches to meet the mental health needs of these adolescents.”

Research title:Implementing lay counsellor-based mental health services to meet the complex needs of youth living with and vulnerable to HIV in Botswana

The issue

Botswana, like many other low- and middle-income countries, has a severely limited mental health professional infrastructure. Only 1% of health expenditures in Botswana are used for mental health treatment, far less than justified by the burden of disease. Botswana’s mental healthcare professional shortage is exacerbated for young people because available professionals often lack the training needed to work effectively with young people. Our previous work in Botswana illustrates these facts. The burden of mental illness is high.

Up to 40% of young people living with HIV and orphans and children vulnerable to HIV have high rates of symptoms of depression or anxiety or substance use disorder – which is almost double international estimates of 20%. Mental health stakeholders in Botswana feel overwhelmed and, like other mental health workers in places with a sparse mental health workforce, are forced to triage resources to only the most severe cases, such as those with active suicidality.

The CIPHER project

AThis project will help Dr Brooks and her team understand the health-seeking behaviours of adolescents living with and vulnerable to HIV, and allow them to pilot mental health services in unconventional settings. With Dr Lowenthal’s mentorship, they will do the following to understand service delivery for youth living with HIV and those who are vulnerable:

  • Explore their mental health beliefs and treatment preferences.
  • Determine whether it is safe to provide non-professional counselling with professional support available by phone.
  • Begin to understand the practical elements of delivering mental healthcare to this group in low-resource, community-based (non-clinical) settings.

CIPHER will provide the resources for Dr Brooks and her team to interview young people on their mental health beliefs and preferences and to apply a version of the lay counsellor intervention that is responsive to all young people living with and vulnerable to HIV, regardless of whether they are in school, housing insecure or dealing with stigma, or whether poverty interferes with their ability to meet mental healthcare needs.

The impact

Dr Brooks prioritized communication with the Botswana Ministry of Health and Wellness from the onset of her project. She hopes that the relationships will allow for immediate integration into the strategic plan of expanding mental health services for adolescents living with HIV. In addition, the project capacitates young adults as lay counsellors, providing them with valuable skills that they can offer to their friends, themselves and their communities and use in their future work as interns and community health workers within the existing structures in Botswana.

For more on Merrian Brooks:


Email: [email protected]

1st International Paediatric HIV Symposium in Africa - Virtual Symposium 17-18 November 2021




Annual international workshop on “Children and Adolescents HIV-Exposed and Uninfected”

CIPHER Grant Programme
Awards up to $150,000 to early-stage investigators to address critical research gaps in paediatric and adolescent HIV in resource-limited settings.

CIPHER Growing the Leaders of Tomorrow Fellowship
Provides support to young investigators in sub-Saharan Africa on priority research topics in paediatric and adolescent HIV clinical science.

CIPHER Global Cohort Collaboration
Brings together the largest collaboration of paediatric and adolescent HIV observational cohort networks to answer key questions of global public health.

Research agendas for paediatric and adolescent HIV