Healthy Choices to Reduce Stigma and Improve Self-Management of Alcohol and HIV among Young Adults - Healthy Choices is a four-session behavior change communication intervention that was developmentally tailored for emerging adults to address self-management of health behaviors and HIV with evidence of positive effect on stigma and depression, built on Motivational Enhancement Therapy, integrating Motivational Interviewing with brief cognitive-behavioral strategies. Healthy Choices can be delivered in community settings by trained community health workers. When delivered with fidelity and in adequate dose, Healthy Choices results in reductions in alcohol use, HIV stigma, viral loads, and depression over follow-up compared to standard care. In the Dominican Republic, stigmas harm young people with HIV (YPWH). The Dominican Republic is a low- to middle- income country in the Latin America and Caribbean region, is 1 of 5 countries that accounts for over 95% of Caribbean HIV infections and has a culture that perpetuates stigmatizing attitudes and behaviors toward YPWH. To our knowledge, there are no Spanish-language interventions that concurrently address mental health, viral suppression, and stigma, tailored for young adults who are in a developmental period marked by exploration and a need for autonomy in health decision making. Considering the need for stigma reduction among YPWH to improve rates of viral suppression, reduce poor mental health, and encourage healthy coping by reducing problem alcohol use, we propose to adapt Healthy Choices for Spanish with local contexts plus co-create implementation strategies with community advising for future scale up. We will pilot test the adapted intervention and proposed intervention strategies, using a community-led implementation approach for feasibility, acceptability, and to assess for a signal of potential effectiveness on continuum of care outcomes including antiretroviral adherence and viral load. Considering the importance of context and the community-orientation of this study, we will apply the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation science model, focusing on the Exploration and Preparation phases. We will engage community-based organizations (CBO) and a clinic in the Dominican Republic that work extensively with YPWH. Our investigator team has a long history of successful collaboration with impact on public health policy in the Latin American and Caribbean region. We propose three aims: (1) Elucidate barriers and implementation strategies for the Healthy Choices intervention; (2) Adapt and culturally translate the intervention for local contexts, and (3) Pilot test Healthy Choices with implementation strategies for feasibility and acceptability. If successful, we will have preliminary data for a full-scale hybrid type 1 effectiveness implementation randomized controlled trial of the intervention for underserved Spanish-speaking YPWH in the Dominican Republic with potential relevance to Spanish-speaking groups in the United States.
