Virtual reality mindfulness intervention for supporting people with HIV and substance use

The syndemic of substance use and HIV continues to pose a significant public health challenge in the United States. Substance use is both a driver and a consequence of poor HIV-related health outcomes, contributing to delayed diagnosis, reduced treatment adherence, and worse clinical outcomes among people with HIV (PWH). National data show that PWH have substantially higher rates of substance use disorders than the general population, with substances such as cocaine, methamphetamine, and opioids linked to suboptimal HIV care engagement and reduced viral suppression. Thus, there is a pressing need for scalable, effective interventions to support people with comorbid HIV and substance use (PWHS). Mindfulness-based interventions (MBIs) are particularly promising for supporting PWHS, as they not only can improve both HIV and substance use outcomes but also promote physical, mental, and spiritual health holistically. Despite these benefits, individuals with or without HIV/substance use issues often struggle with initiating or maintaining a mindfulness practice, limiting the effectiveness of traditional MBIs. Virtual reality (VR) technology offers a novel solution, providing immersive, interactive experiences that can significantly enhance user engagement and mindfulness practice adherence. However, no VR-based MBI has yet been evaluated among PWHS. Addressing this gap, we propose to examine the feasibility and acceptability of “TRIPP,” a commercially available VR-based MBI, in supporting PWHS. Guided by the NIH Stage Model for Behavioral Intervention Development, this study will achieve the following aims. Aim 1: To address potential implementation barriers (e.g., limited technological literacy), we will collaborate with community partners using the principles of co-design workshop planning to create an orientation video that systematically walks users through the setup and usage of the TRIPP VR application. Aim 2: Assess the feasibility and acceptability of TRIPP through a pilot trial with 30 PWHS participants using TRIPP 3-5 times weekly for four weeks. Primary outcomes are intervention acceptability, appropriateness, and feasibility. Secondary outcomes are protocol feasibility (e.g., recruitment, retention). Aim 3: Conduct focus groups to collect feedback from participants and clinical staff to inform future adaptations of TRIPP.