Impact of a novel HIV peer navigationand overdose prevention intervention on engagement in the HIV prevention and treatment cascade.

Project Summary People who inject drugs (PWID) are at exceedingly high risk of HIV compared to the general population, yet pre-exposure prophylaxis (PrEP) programs that target them in the U.S. are scarce and accordingly PrEP uptake in this population remains low. In recent years, substance use services have been scaled up to address overdose among PWID, however, they remain an underutilized entry point into PrEP. Pivotal gains made in reducing HIV could be rapidly eroded by the expanding population of PWID attributed to the ongoing opioid epidemic, new HIV outbreaks among new injectors, and the emergent COVID-19 pandemic, which has disrupted key HIV prevention services including syringe services programs, treatment and condom distribution. The overarching aim of the RADAR (Rapid Alerts through Drug Analysis and Response) study is to design, implement and evaluate a mobile health van that provides on-site PrEP, peer navigation and co-located drug checking services (DCS). This study will expand the reach of PrEP services by offering a novel intervention designed to increase PrEP awareness and engagement. DCS enable PWID to understand the precise chemical contents of their drugs to inform safer drug practices and are critical in places where illicit fentanyl drives overdose mortality. The integration of peer navigation will help attend to the multiple, pressing needs of PWID and subsequently enhance their engagement in the PrEP continuum. Our specific aims are: (1) to develop a community-level, mobile, integrated PrEP intervention aimed to increase PWID engagement in the PrEP care continuum; (2) to implement the intervention through a stepped wedge cluster randomized trial and evaluate its impact on being on PrEP or having seen a PrEP provider in the last six months among PWID (N=600) over the course of 18 months; (2a) to measure the intervention’s impact on HIV risk behaviors (e.g., syringe sharing, condomless sex); and (3) to determine the incremental cost-effectiveness of the intervention in terms of HIV cases averted among PWID (N=600) over the course of 18 months. The intervention (on-site PrEP, peer navigation, SMS reminders, DCS and associated risk reduction counseling, standard-of-care services) will be compared to the standard-of-care only (HIV testing, PrEP referrals, fentanyl test strips, naloxone) condition. The proposal is directly responsive to PAR-18-915’s aim to leverage implementation science to improve each step of the Seek, Test, Treat, and Retain (STTR) continuum for PWUD as well broader NIH priorities to reduce HIV incidence and develop, test, and implement strategies to improve HIV testing and entry into prevention and care. The study is innovative as it attends to multiple comorbidities, it is inclusive of the expertise of PWID in all components of the study and builds on our experience in delivering outreach services during COVID-19.