5 - (IOP 21) Optimizing a Brief MI-CBT Intervention for HIV and Alcohol Management in Florida Youth with HIV Using Innovative Designs for Adaptive Interventions

Despite decades of research on behavioral interventions to improve management of HIV and alcohol in emerging adults (ages 18-29), there is only one intervention that has been shown to improve viral burden and alcohol use in young people with HIV (YPWH) in full-scale randomized trials. Healthy Choices was adapted and developmentally tailored for emerging adults to address self-management of risk behaviors and HIV. Based on Motivational Enhancement Therapy, Healthy Choices is a 4-session alcohol intervention in SAMHSA’s registry of evidenced-based programs that includes both MI and CBT strategies. Healthy Choices showed effects on viral suppression, alcohol use, cannabis use, and condom use, along with improving perceived stigma and depression. This is despite most youth not completing all four sessions. Furthermore, these studies were conducted within a research network of primarily academic medical centers. Thus, we sought to optimize the intervention for youth across the state of Florida by first exploring new identity-based factors relevant to self-management and then leveraging these findings into a hybrid micro-randomized trial (MRT) to optimize intervention efficacy and efficiency. In a cross-sectional, formative study, trauma symptoms, discrimination, racial microaggressions, as well as difficulty regulating emotions and poorer psychological functioning were related to alcohol use. Alcohol use in turn was related to poorer ART adherence. Higher executive functioning (e.g., organization and planning) was also related to higher medication adherence. These findings were incorporated into an intervention trial to optimize Healthy Choices. In collaboration with youth advisors, we designed a hybrid MRT that includes two simultaneous MRTs: one on a slow timescale and one on a fast time scale. For the slow time scale, all YPWH receive one mHealth session and are then randomized every two weeks for six weeks for up to 3 more live telehealth sessions. For the fast time scale, the same youth are simultaneously randomized daily to receive intervention text messages related to managing stressors, messages relating to adherence or no message. Design decisions, preliminary findings and lessons learned will be discussed.