Peer-Led Alcohol Reduction and HIV Prevention for Pregnant Women in South Africa (Mentor Moms+)

The Mentor Moms+ study addresses the critical intersection of alcohol use and HIV risk among pregnant and lactating individuals (PLP) in South Africa. This community-based adaptation of a peer-led intervention aims to improve maternal and child health outcomes by reducing alcohol consumption and enhancing adherence to HIV prevention strategies.

South Africa faces a syndemic where alcohol use during pregnancy exacerbates HIV-related risks, including delayed antiretroviral therapy (ART) initiation, poor adherence, and increased vertical transmission. Pregnant women without HIV who consume alcohol are also at higher risk of acquiring HIV, necessitating targeted interventions like pre-exposure prophylaxis (PrEP).

The study leverages the evidence-based "mentor mother" (MM) model, which employs trained peer mentors (mothers with lived experience) to deliver behavioral interventions. In this pilot randomized controlled trial (RCT), 100 pregnant women who report recent alcohol use will be assigned to either:

• MM+ Intervention: Receives brief motivational interviewing (MI) sessions from mentor mothers, focusing on alcohol reduction, HIV risk management, and ART/PrEP adherence. Includes biofeedback via EtG (alcohol) and urine tenofovir (PrEP/ART) testing.
• Enhanced HIV Attention Control (eSOC): Receives standard HIV education, partner testing support, and adherence counseling without alcohol-specific components.

Primary outcomes include reduced alcohol use measured via:

• Objective: Dried blood spot (DBS) phosphatidylethanol (PEth) levels (<20 ng/mL = light/no use).
• Self-report: AUDIT-C scores (0 = abstinence).

Secondary outcomes assess HIV-related behaviors:

• PrEP initiation and adherence (via urine tenofovir).
• ART adherence (via urine tenofovir, reflecting 48–72-hour adherence).

Conducted by UCLA in collaboration with NIAAA, San Diego State University, and the University of Cape Town, this study (2025–2027) seeks to establish the feasibility and acceptability of integrating alcohol reduction into existing peer-led HIV interventions for PLP in resource-limited settings.