"Gwan Enjoy Life:" A Peer-Supported Mental Health Mentoring Intervention to Improve Engagement in Care Among Sexual Minority Men Living With HIV in Jamaica

Assessed using the Patient Health Questionnaire-9 (PHQ-9) to measure severity of depressive symptoms over the past two weeks. It scores symptoms experienced over the past two weeks on a scale from 0 to 27.

Scoring and Severity 0-4 points: Minimal or no depression 5-9 points: Mild depression 10-14 points: Moderate depression 15-19 points: Moderately severe depression 20-27 points: Severe depression

Measured using the Generalized Anxiety Disorder-7 (GAD-7) to assess symptoms of anxiety. The GAD-7 is a brief, seven-item self-report questionnaire used to screen for generalized anxiety disorder and measure symptom severity. Patients rate how often they experienced specific anxiety symptoms over the past two weeks on a scale from 0 to 3, yielding a total score between 0 and 21. Score Interpretation: 0-4: Minimal anxiety; 5-9: Mild anxiety; 10-14: Moderate anxiety (a score of 10 or higher is typically the cut-off point where further clinical evaluation is recommended); 15-21: Severe anxiety

Assessed using the UCLA Loneliness Scale (8-item short form) to measure perceived social isolation

The scale features 20 statements (e.g., "I lack companionship", "I feel isolated from others"). Participants rate each statement using a 4-point scale: Never (1), Rarely (2), Sometimes (3), and Often (4). Positive items are reverse-scored. Total scores range from 20 to 80, with higher numbers showing higher levels of loneliness.

The Kessler Psychological Distress Scale (K10) is a quick questionnaire used to measure recent signs of anxiety and depression, which asks 10 simple questions (nervousness, agitation, fatigue, and depression) about how a person felt over the past 30 days. Answers are ratedf rom 1 ("none of the time") to 5 ("all of the time"). Total scores range from 10 to 50 by adding up all the answers. The scores mean: 10-15: Low or no distress (likely well); 16-21 (or up to 24): Mild distress or mild mental disorder; 22-29 (or 25-29): Moderate distress or moderate disorder; 30-50: High or severe distress requiring help

The Columbia Suicide Severity Risk Scale (C-SSRS) is is a brief, evidence-based screening tool used to evaluate suicide risk. It relies on simple, plain-language questions to assess the severity of suicidal ideation, preparation, and behavior without requiring formal mental health training to administer. The scale does not yield a single total score, but rather categorizes risk levels using specific subscales: suicidal ideation severity (scored 1 to 5), ideation intensity (scored 2 to 25), and suicidal behavior (binary yes/no ratings). The highest possible score on the Intensity of Ideation subscale is 25.

The Brief Resilient Coping Scale (BRCS) is a short, four-item questionnaire use to measure how well a person uses adaptive strategies to cope with stress. The total score ranges from 4 to 20, with higher numbers showing a stronger ability to handle tough situations. Participants rate four items on a 5-point scale, ranging from 1 ("does not describe me at all") to 5 ("describes me very well"). The items focus on proactive, positive, and creative approaches to managing difficult situations, controlling reactions, and addressing losses. Score Interpretation: 4 to 13: Low resilient coper; 14 to 16: Medium resilient coper; 17 to 20: High resilient coper

The Medical Outcomes Study (MOS) Social Support Survey is a 18-item, self-administered questionnaire measuring functional social support across four key domains: emotional/informational support, tangible support, affectionate support, and positive social interaction. The scale is structured around 4 domains: 1) Emotional/Informational Support (8 items): Expressions of empathy, guidance, or feedback; 2) Tangible Support (4 items): Provision of material aid or instrumental assistance; 3) Affectionate Support (3 items): Expressions of love and affection; and 4) Positive Social Interaction (3 items): Availability of others to do fun things with. Responses are recorded on a 5-point Likert scale ranging from 1 ("none of the time") to 5 ("all of the time"). Higher Scores indicates higher perceived availability of functional social support.

Measured via medical chart review: clinic attendance, missed visits, and visit constancy.

Retention in care will be measured using objective clinical indicators derived from medical records, supplemented where necessary by participant self-report:

• Clinic attendance: Number and proportion of scheduled HIV care appointments attended over the study period, abstracted from clinic records.
• Missed visits: Number of missed or delayed appointments (e.g., no-shows or visits outside recommended intervals).
• Visit constancy: Presence of at least one completed visit within each predefined interval (e.g., quarterly), consistent with standard retention metrics in HIV care research.

Assessed via clinical records including prescription refill data and treatment status

HIV viral load (<200 copies/mL) extracted from medical records to determine suppression status.

Viral suppression will be assessed using laboratory-confirmed HIV viral load data extracted from medical records:

• Primary indicator: Proportion of participants achieving viral suppression, defined as HIV RNA <200 copies/mL, consistent with international clinical guidelines.
• Secondary indicator: Maintenance of viral suppression across consecutive measurements, where available.

Immune status measured via CD4 laboratory values from clinical records

The Theoretical Framework of Acceptability (TFA) comprises of seven core domains used to construct evaluation surveys for measuring how recipients perceive a healthcare or behavioral intervention. Acceptability is assessed using a Likert-scale (strongly agree to strongly disagree) items mapped to each of the domains (affective attitude, burden, perceived effectiveness, self-efficacy, ethicality, opportunity costs, and intervention coherence).

Participation in core intervention components (e.g., number of peer-support sessions completed)