# SMARTer Healthy Choices: Optimizing a state-wide scalable intervention to improve alcohol and HIV self-management in adolescents and emerging adults (Project SUSTAIN)

> **NIH NIH P01** · FLORIDA STATE UNIVERSITY · 2023 · $129,612

## Abstract

SUSTAIN ABSTRACT
Despite decades of research on behavioral interventions to improve management of HIV and alcohol and on
the high rates of risk behaviors 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 living with HIV (YPLWH) in full-scale trials with
sufficient rigor to be published in JAMA journals. Healthy Choices, was adapted and developmentally tailored
for emerging adults to address self-management of risk behaviors and HIV from Motivational Enhancement
Therapy, a brief alcohol intervention in SAMHSA’s registry of evidenced-based programs. We will now conduct
a hybrid Type 1 comparative effectiveness-implementation trial to develop an adaptive intervention (one where
dose and delivery format can be tailored). The first randomization compares an existing brief mHealth MI-
based self-management intervention (THRIVE) versus brief mHealth plus a single telehealth session of Health
Choices. We move beyond a traditional clinical trial by utilizing a SMART design (Sequential Multiple
Assignment Randomized Trial) as an efficient and rigorous way to explore additional questions to optimize
interventions and maximize real-world implementation such as: 1) is there a need for an additional THRIVE
check-up among YPLWH who report >80% adherence AND no NIAA-defined hazardous drinking after one
month (responders); and 2) for YPLWH who report <=80% adherence AND hazardous drinking at 1-month
follow-up (non-responders) which is more effective and economical, the remaining three sessions of Healthy
Choices are delivered via telehealth versus mHealth. As another innovation, we include behavioral, biomarker
and pragmatic outcomes. We plan to recruit a diverse sample of 300 YPLWH across Florida who report any
alcohol use and ≤80 percent adherence to antiretroviral treatment (from clinics, community organizations, and
social media) and collect data at baseline, 3, 6, and 12 months. The goal of PROJECT SUSTAIN is to optimize
Healthy Choices to advance an adaptive and sustainable intervention designed to improve self-management of
alcohol and HIV in YPLWH while understanding the context for state-wide implementation and sustainment in
an effectiveness-implementation Type 1 Hybrid SMART. The primary aim is to compare THRIVE, an mHealth
intervention adapted to target self-management of alcohol and HIV, with THRIVE plus a single telehealth
session of Healthy Choices. In a single session we can build motivation for alcohol and HIV management but
not address the range of self-management skills. Thus, we also aim to understand the benefit of the remaining
three Healthy Choices sessions for non-responders, to compare the effectiveness of delivery of these sessions
by telehealth or mHealth, and to determine the benefit of mHealth boosters for responders. Finally, we prepare
for state-wide implementation by studying barriers and facilitators from multiple stakeholders using an
establ...

## Key facts

- **NIH application ID:** 10678992
- **Project number:** 5P01AA029547-03
- **Recipient organization:** FLORIDA STATE UNIVERSITY
- **Principal Investigator:** SYLVIE NAAR
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $129,612
- **Award type:** 5
- **Project period:** 2021-09-10 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10678992

## Citation

> US National Institutes of Health, RePORTER application 10678992, SMARTer Healthy Choices: Optimizing a state-wide scalable intervention to improve alcohol and HIV self-management in adolescents and emerging adults (Project SUSTAIN) (5P01AA029547-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10678992. Licensed CC0.

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