"I can be a source of motivation": Perspectives from stakeholders of the I'mPossible fellowship, a peer-led differentiated service delivery model for adolescents with perinatally acquired HIV in India.

Youth living with perinatally acquired HIV (APHIV) in India face layered challenges; peer-led differentiated care models show promise but remain underexplored. We examined multi-stakeholder perceptions within the I'mPossible Fellowship, a peer-support DSD intervention addressing APHIV health, education, and livelihoods From May-December 2023, we enrolled three stakeholder groups: (1) intervention deliverers (APHIV "fellows" 18-27 yrs), (2) facilitators ("supervisors" of APHIV), and (3) recipients(APHIV "peers" in care, 8-26 yrs). We conducted interviews with 8 fellows (75% female, mean age 22.5) and 7 supervisors; and three focus group discussions with 18 peers (mean age 16.7). Audio-recorded data were transcribed, translated, and thematically analyzed using deductive coding and triangulation across groups to examine fellows' roles and program impact. Five key themes emerged, highlighting the layered influences of the I'mPossible Fellowship. First, mentorship provided informational and emotional support for peers; second, peer influence arising from peer-to-peer interactions contributed to a sense of trust and affirmation. Third, fellows' personal growth stimulated their motivation to fulfil their mentorship roles effectively. Fourth, stigma and poor preparedness for transition into adult care hindered educational, employment and independent living opportunities for APHIV. Fifth, sustainability, through continued mentoring support, was emphasized by supervisors and fellows as crucial for supporting APHIV in transitioning to independent living. This study highlights the pivotal role of fellows and peer mentorships in addressing the multilevel factors that enhance outcomes for APHIV. By providing knowledge and empathy to their peers and serving as credible role models with lived experience of HIV, fellows within the I'mPossible fellowship exemplify a successful DSD model incorporating the three essential attributes of peer support: informational, emotional, and affirmative support. These findings underscore the importance of integrating peer-led interventions into HIV care and reframes youth as active agents of change, recognizing their capacity for meaningful societal contribution.