STOP (Shared decision making to Treat Or Prevent) HIV in Justice Populations

ABSTRACT The United State’s Ending the HIV Epidemic (EHE) plan’s primary goal is to reduce new HIV infections by 90% by 2030 through providing rapid pre-exposure prophylaxis (PrEP) for those who test negative for HIV (PREVENT) and rapid antiretroviral therapy (ART) for those who test positive for HIV (TREAT). The EHE plan, however, does not integrate substance use disorder (SUD) assessments and treatments nor provide implementation strategies on providing PrEP/ART for persons who use drugs (PWUD) and are involved in the justice system, a population that critically needs these services. PWUD with justice involvement are more likely to acquire HIV and have SUDs than the general population and have a disproportionately higher level of unmet social needs, including lack of housing and transportation, that may supersede their SUD and HIV prevention/ treatment needs. While evidence-based HIV and SUD prevention and treatment services are well known, best practices on how to implement PrEP/ART and SU/SUD treatment services from a patient-centered approach for PWUD involved in the justice system are critically needed to meet these EHE goals. (R61): We will focus on one community (CT) to develop our patient choice menu of options to access PrEP/ART and SUD treatment services for PWUD involved in the justice system and pilot the intervention (PN+PC). (R33): Information from the R61 pilot will inform our proposed Hybrid Type 3 implementation effectiveness trial of the final PN+PC model in four communities (CT, Dallas and Tarrant Counties, TX, and KY) using the same eligibility as in the R61. We will evaluate Patient Navigation (PN) compared to PN+PC on patient-level outcomes including proportion who (a) access a clinician for PrEP/ ART and (b) receive treatment (ART /PrEP); and SU/SUD treatment services. We will evaluate system-level outcomes and costs associated with implementing changes and their outcomes.