Ethiopia is experiencing an increasingly urban, female-centered HIV epidemic alongside a rise in rural migration of adolescents to Addis Ababa. Often these migrants are confronted by social challenges such as lack of education, inadequate housing, unstable employment conditions, and physical and sexual abuse. These difficult living circumstances contribute to psychological and mental health problems among these vulnerable adolescents, potentially putting them at greater risk of acquiring HIV. However, knowledge about how targeted mental health interventions can impact HIV-related outcomes worldwide, and in Ethiopia, remains limited. OBJECTIVES The goal of this study was to pilot test a strategy for addressing mental health problems, such as stress, anxiety, depression, and emotional and behavioral issues, as well as measure if the provision of a tailormade psychosocial support intervention can affect HIV-related outcomes among vulnerable migrant adolescents in Addis Ababa, Ethiopia. The specific objectives of this study were to pilot test a targeted psychosocial support counseling intervention and document any changes in : 1) psychological and mental health problems of the target population; and 2) responsiveness to HIV programming and services among the target population. METHODS Study design This was a before and after intervention study comprising a cohort of migrant male and female adolescents aged 15 to 18 years old in Addis Ababa, Ethiopia receiving services from two service delivery organizations-Biruh Tesfa and Retrak. Biruh Tesfa works with migrant young women who are predominantly employed as domestic workers, while Retrak works with young men in Addis Ababa who are often engaged in street labor activities. Participants were screened using the Youth Self-report (YSR) tool and a behavioral survey at baseline, then delivered a three-month psychosocial counseling pilot intervention. The intervention was followed by an endline YSR and behavioral survey. Due to ethical concerns, participants with severe mental health issues at baseline (N=24) were referred to clinical services for appropriate treatment and follow-up care, and thus excluded from the study. Description of the intervention The study intervention consisted of the delivery of a client-driven, psychosocial counseling intervention, administered by trained counselors, which discussed adolescent development, psychological wellbeing, mental health problems, and factors increasing vulnerability of marginalized adolescents. Study counselors administered the targeted counseling intervention, which included both individual and group counseling sessions, such as creative art therapies and music, drama, and dance (MDD), to all consenting enrolled participants from the two Addis Ababa-based service delivery organizations of Biruh Tesfa and Retrak.