"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 HIV (YLHIV) face multidimensional challenges, including stigma, mental health struggles, and socioeconomic instability, which are further magnified among adolescents and young adults with perinatally acquired HIV (APHIV). Peer-led differentiated service delivery (DSD) models providing tailored support for this population have demonstrated improved outcomes, though their adaptation and implementation in India remain underexplored. We examined multi-stakeholder perceptions within a peer-support DSD intervention in India, the I'mPossible Fellowship, designed to address the health, educational, and livelihood needs of APHIV. Between May and December 2023, we enrolled three stakeholder groups involved in the I'mPossible fellowship intervention: (1) intervention deliverers (APHIV "fellows"), (2) facilitators ("supervisors" of APHIV), and (3) beneficiaries (APHIV "peers"). To examine fellows' roles and growth, we conducted in-depth interviews with fellows (n=8; 75% female; mean age: 22.5 years) and supervisors (n=7). Aiming to explore fellow-peer interactions and perceived program impact, we conducted three focus group discussions with purposefully sampled peers (n=18; 66.7% male; mean age: 16.7 years). Data collected were audio recorded, transcribed, and translated from Kannada to English for coding and analysis. Thematic deductive analysis was combined with data triangulation across participant groups to synthesize findings. Five key themes emerged, highlighting the layered influences of the I'mPossible Fellowship. First, mentorship was an important theme that 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, personal growth experienced by fellows stimulated their motivation to fulfil their mentorship roles effectively. Fourth, complex systemic challenges, such as stigma and discrimination, hindered educational and employment advancement of APHIV. Fifth, sustainability, through robust post-fellowship systems and 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 the bi-directional power of 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. While these findings underscore the importance of integrating peer-led interventions into HIV care frameworks to support youth with HIV, this also reframes youth as active agents of change, recognizing their capacity for empowerment and meaningful societal contribution rather than passive recipients of care.