Project Adelante: Scaling Brief Mental Health Support within HIV Care Settings in Puerto Rico

Summary

Many adolescents and young adults living with HIV struggle with depression, stress, and stigma.¹ These challenges can make it harder to stay engaged in care and maintain viral suppression.² In Puerto Rico, mental health conditions occur at higher rates than in the continental U.S., yet many people do not receive treatment.³ Mental health services are often separated from HIV clinics, require referrals, and involve long wait times. As a result, young people living with HIV may not receive timely support. There is a clear need for brief, practical mental health services that can be delivered directly within HIV care settings.

Our team will adapt, pilot, and evaluate the Single Session Consultation (SSC) within an HIV clinic in Puerto Rico. We will begin by working directly with adolescents and young adults living with HIV through a Youth Advisory Board and with clinic staff through a Community Advisory Board. In small group sessions, participants will review the session materials, walk through the visit step by- step, and share feedback on language, examples, and cultural fit. We will revise the session after each round of feedback to ensure it reflects local values and clinic realities.

Next, we will train two lay behavioral health counselors at the clinic to deliver the SSC during routine HIV care. Young adults who screen positive for depression will be invited to participate. We will follow participants for six months, collecting surveys on mood and care engagement and measuring HIV viral load through routine blood draws. We will also interview participants and staff about their experience and track how closely sessions follow the protocol. These data will help us refine the program and prepare for a larger trial.^4,5

Significance

This project offers a practical way to integrate mental health support into routine HIV care. If successful, the SSC could improve depression symptoms and increase viral suppression among young people living with HIV. Clinics benefit from a scalable model that does not rely on specialty mental health providers. Community partners gain training materials and implementation tools to sustain the program. The findings may inform HIV clinics across Puerto Rico and the continental United States seeking efficient, culturally responsive ways to strengthen engagement in care and improve long-term health outcomes.

Latino adolescents and young adults living with HIV face higher barriers to mental health care, including language differences, stigma, cost, and limited access to specialists. By embedding brief mental health support within HIV clinics and training lay providers, this project reduces structural barriers and expands access to care. Cultural and linguistic adaptation ensures the program reflects local values and experiences rather than applying a one-size-fits-all model. By improving both mental health and HIV outcomes in an underserved population, this research advances health equity and supports more inclusive care systems. 

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Clinical & medical benefits

Integrate a brief therapeutic procedure into routine HIV care. potential.

Clinical innovation access

Primary beneficiary:

Clinicians

Community & public health benefits

Provide mental health services at HIV clinics for young adults. potential.

Community health services

Primary beneficiary:

Patients

Generate health education resources and implementation guidance to support broader scale-up. potential.

Health education resources

Primary beneficiary:

Service providers

Deliver brief mental health support within HIV clinics, reducing barriers related to cost, stigma, transportation, and limited availability of specialty providers. potential.

Health care accessibility

Primary beneficiary:

Communities / Public

Train lay clinic staff to provide structured, evidence-based mental health consultations during routine HIV visits, improving coordination of services within existing clinic workflows. demonstrated.

Health care delivery

Primary beneficiary:

Service providers

Reduce HIV-related disease progression and transmission risk by embedding brief mental health support within HIV clinics to improve depression symptoms treatment adherence, and sustained viral suppression among adolescents and young adults living with HIV. potential.

Disease prevention & reduction

Primary beneficiary:

Patients

Improve long-term quality of life and potential life expectancy for adolescents and young adults living with HIV by addressing depression early and strengthening consistent engagement in HIV treatment. potential.

Life expectancy & quality of life

Primary beneficiary:

Patients

Integrate a culturally adapted, lay provider-delivered single-session mental health intervention into routine HIV clinic services in Puerto Rico to strengthen depression screening, care engagement, and viral suppression among adolescents and young adults living with HIV. potential.

Public health practices

Primary beneficiary:

Communities / Public

Economic benefits

Reduce the social and financial costs of HIV by improving depression management and viral suppression, which may decrease treatment complications and long-term productivity losses among young people living with HIV. potential.

Societal & financial cost of illness

Primary beneficiary:

Communities / Public

This research has clinical, community, and economic implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.⁶ 

Clinical

Adolescents and young adults living with HIV in Puerto Rico will benefit from receiving brief, culturally responsive mental health support during routine HIV clinic visits. By reducing depression and strengthening motivation for care, the program is expected to improve viral suppression and overall well-being. Clinics will gain a practical, scalable model that enhances care without requiring additional specialty staff. Early benefits are expected during the study period through improved patient experience and clinical outcomes, with broader impact anticipated as the model expands to additional clinics in Puerto Rico and to Latino communities in the continental U.S.

Community

This project improves community health by increasing access to mental health services in HIV clinics serving Latino youth. Embedding support within routine care reduces barriers such as long wait times, workforce shortages, and stigma. Improved mental health and viral suppression can lower the risk of HIV transmission and strengthen retention in care at the population level. Clinics benefit from a sustainable model that enhances service delivery. As the approach spreads to additional settings, it has the potential to improve public health outcomes and advance equity in communities disproportionately affected by HIV.

Economic

Improving depression management and achieving viral suppression among young people living with HIV can significantly reduce the social and financial costs associated with the condition. Effective depression management helps enhance treatment adherence, leading to better viral suppression. This, in turn, reduces the likelihood of treatment complications and lowers healthcare costs. Additionally, when young people are mentally healthy and have their HIV under control, they are more likely to stay productive and maintain long-term engagement in work and educational activities. Ultimately, this dual focus on mental health and HIV management can decrease long-term productivity losses and reduce the economic burden on both individuals and the community. The integration of mental health support within routine HIV care, as proposed by Project Adelante, aims to provide this comprehensive and cost-effective approach.

Lessons Learned

Strong community partnership has shaped this proposal from the start. Collaboration with HealthproMed and a local Community Advisory Board ensures the intervention reflects Puerto Rico’s language, culture, and clinic workflows. Designing the program for lay provider delivery makes it feasible in settings with limited mental health specialists. Embedding the intervention within routine HIV visits further supports accessibility, scalability, and long-term sustainability.