Implementing Integrated Services for People With HIV and Opioid Use Disorder

Project Summary This application proposes a five-year mentored training program to develop a well-trained physician-scientist in implementation science, infectious diseases, and substance use disorders. The multipronged training plan includes coursework, focused research projects, and mentorship from experts in the fields of health services research, implementation science, addiction medicine, mixed methods, and biostatistics. Implementation scientists are of critical importance to help effectively address the global burden of the dual HIV and opioid epidemics. Medications for opioid use disorder (MOUD) improve both HIV and opioid use disorder (OUD) outcomes but access to treatment has not been scaled to meet the need nor has treatment been integrated into HIV care services, despite international recommendations to do so. Implementation strategies are needed to bridge the gap between the evidence and “real-world” practices in order to increase the accessibility of MOUD to people living with HIV/OUD. The integrated Promoting Action for Research in Health Services (i-PARiHS) implementation science framework is ideally situated to scale up integration of MOUD and HIV treatment services. It posits that 3 elements are central to successful adoption and scale-up: 1) an appraisal of the strength of the evidence and meaning to practitioners, 2) an evaluation of the local context, and 3) effective facilitation. The NIATx treatment improvement model is an evidence-based practice facilitation strategy designed to increase organizational capacity to perform effective process improvement. Coaching, collaborative learning, and interest circles are utilized and allow for a tailoring of the strategy within the intended context and needs of the organization. The proposed research will be conducted in New Jersey, a state profoundly impacted by the dual opioid and HIV epidemics and has 2 of the 48 counties that are priorities for the Ending the HIV Epidemic plan. Study aims: 1) Conduct a statewide, multi-level gap analysis of treatment for HIV and OUD in New Jersey. A mixed method study will be conducted with patients, providers, clinic administrators/directors, and key stakeholders from the community/government to provide a multi-level assessment of the barriers and facilitators of integrating MOUD and HIV care/prevention. 2) Using the i-PARiHS implementation science framework, evaluate the effectiveness of using the evidence-based facilitation strategy in the NIATx Treatment Improvement Model to scale up integrated HIV and OUD services. Using a stepped-wedge cluster randomized trial design, participating HIV clinics and Opioid Treatment Programs will receive coaching (facilitation) to guide rapid cycle change projects. The primary health services outcome will be changes in MOUD prescriptions and the primary implementation outcome will be the degree of adoption of MOUD treatment in HIV settings. These research aims are supported by a complementary training and mentorship program and, taken together, will enable the candidate to become an independently-funded investigator at the intersection of infectious diseases, substance use, and implementation science.