JMIR Publications

ABSTRACT

Background:

Young people with HIV (YPWH) experience disproportionately poor outcomes across the HIV care continuum, high levels of stigma, and elevated alcohol and other substance use. Healthy Choices is a 4-session intervention that integrates Motivational Interviewing with brief cognitive-behavioral strategies and has demonstrated positive impact on HIV stigma, alcohol use, depression, and viral load in prior trials among YPWH. Interventions such as Healthy Choices have the potential for improve the HIV continuum of care in Caribbean settings. However, no interventions have been adapted for Spanish language and pilot tested to concurrently address stigma, mental health, alcohol use, and viral burden among YPWH in the Dominican Republic.

Objective:

This study aims to adapt Healthy Choices for Spanish speaking YPWH in the Dominican Republic context and pilot test the adapted intervention with implementation strategies to assess feasibility, acceptability, and a directional signal of potential for impact.

Methods:

Guided by the Exploration, Preparation, Implementation, Sustainment framework and the Health Stigma Framework, this 36-month study has 3 Specific Aims. In Aim 1, we will conduct focus groups with community representatives and in-depth interviews with YPWH to identify barriers, adaptation needs, and implementation strategies. In Aim 2, we will use ADAPT-ITT and co-design workshops with community partners and a Youth Advisory Board to contextually translate and adapt Healthy Choices into Spanish for the Dominican Republic, and we will train peer navigators. In Aim 3, we will conduct a pilot randomized controlled trial with 45 YPWH using 2:1 allocation to the adapted Healthy Choices intervention (n=30) or a time-attention control (n=15). Primary outcomes are feasibility and acceptability. Secondary and exploratory outcomes include antiretroviral adherence, viral load, alcohol and other substance use, social support, positive affect, coping, depression, and HIV-related stigma assessed at baseline to follow-up.

Results:

Study dates are March 1, 2026 to February 28, 2029. At the time of manuscript preparation, formative partnership development and key-informant consultation had been completed. The study is positioned to proceed through qualitative exploration, intervention adaptation, peer navigator training, and pilot testing across a 36-month project period. Results from the pilot trial are expected after completion of follow-up assessments.

Conclusions:

This protocol describes an implementation science guided approach to adapting and testing a promising intervention for YPWH in a high-priority global setting with translational potential back into the United States, considering the high rate of Spanish speakers. If feasible and acceptable, the study will yield preliminary data for a future full-scale hybrid type 1 effectiveness-implementation trial. Clinical Trial: Pending.