PROJECT SUMMARY The syndemic of alcohol use and HIV risk in pregnant and lactating people (PLP) threatens the health of mother, fetus, children and families in South Africa. PLP living with HIV who use alcohol may access antiretroviral therapy (ART) late or disengage with ART care, increasing the risk of vertical HIV transmission. PLP not living with HIV who use alcohol are at increased risk of HIV and may require targeted interventions to receive pre-exposure prophylaxis (PrEP) delivery and adherence counselling. Alcohol use also increases risk of HIV acquisition and poor ART adherence. The “mentor mother” (MM) intervention model is an evidence- based intervention (EBI) with demonstrated success in improving HIV and antenatal care outcomes. The model utilizes a task-shifting approach; positive deviant peers (mothers) deliver interventions to PBFW within and outside of the antenatal clinic. In the present study, we will collaborate with community partners to identify facilitators of alcohol use among PLP in SA. We will then adapt the MM model to create MM+ for PLP who use alcohol to evaluate the feasibility of an alcohol reduction intervention that includes HIV prevention and treatment (serostatus neutral) in a high alcohol using and HIV burdened community. Specific aims include: · Aim 1: Mixed methods assessment of perceptions of alcohol use in pregnancy and facilitators of alcohol reduction in pregnancy among multilevel stakeholders of PLP who use alcohol to identify clinic and community level facilitators that could be used to reduce the use of alcohol during pregnancy through in-depth interviews (IDIs) and brief surveys with drinking peers, intimate partners and focus group discussions with healthcare providers and community leaders. · Aim 2: Adapt and refine enhanced MM intervention (MM+) with potential intervention beneficiaries, providers and community leaders. Use community based participatory approach research principles to iteratively adapt, test and refine the MM+ intervention to integrate alcohol reduction content in one collaborative workshop session. · Aim 3: Evaluate the feasibility and acceptability of MM+ on reduction of alcohol use (primary outcome) and PrEP use (in PLP without HIV) and ART adherence (in PLP living with HIV) (secondary outcomes) in a pilot randomized control trial (RCT) in n=100 pregnant women who currently use alcohol. Primary outcome: Reduced alcohol use following the intervention (at 6m via phosphatidylethanol [PEth] levels). Secondary outcomes: PrEP and ART continued use at 6m via urine tenofovir levels at 6m. Secondary implementation outcomes: feasibility (provider, organizational and participant feedback), acceptability and fidelity to the intervention SOPs. Our study seeks to effectively reduce alcohol use and improve HIV care outcomes through community engagement and a novel participant informed intervention adaptation and delivery process.