Integrated Services for PWID using Person-centered Interactions, Reach, and Engagement (INSPIRE)

PROJECT SUMMARY First-ever data from Zambia on people who inject drugs (PWID) demonstrates major gaps in the HIV epidemic response. A recent biobehavioral survey show sharp health disparities along the entire PWID HIV care continuum, with gaps in HIV testing, linkage to ART, and viral suppression, and limited knowledge of PrEP. Failing to detect early HIV infections and address unsuppressed viral load poses a risk of ongoing community transmission as well as increased risk for HIV comorbidities and mortality, threatening the overall HIV epidemic control response in Zambia. The Zambia Ministry of Health has adopted a harm reduction approach to address the health disparities experienced by PWID. Starting in November 2024, the Zambia Ministry of Health will provide Medications for Opioid Use Disorder (MOUD) at two health facilities which also provide HIV services. There is currently minimal evidence in sub-Saharan Africa on MOUD integration with HIV care. The arrival of MOUD in Zamvia presents an exceptional opportunity to collaborate with Ministry of Health and key partners to develop a person-centered integrated collaborative care model for PWID and pilot testing implementation, feasibility, and preliminary effectiveness within the Zambian health system. We propose the Integrated Services for PWID using Person-centered Interactions, Reach, and Engagement (INSPIRE) study to co-adapt and evaluate an HIV status-neutral system-level integrated approach using a Collaborative Care Management Model (CoCM) for HIV prevention, HIV care, mental health, and MOUD. This implementation science study includes the following Aims: Aim 1: Assess the multilevel determinants of early implementation of MOUD services using rapid qualitative analysis. Aim 2: Co-adapt an HIV status-neutral CoCM with key stakeholders. Aim 3: Implement and evaluate the co-adapted CoCM, guided by Practical, Robust Implementation and Sustainability Model (PRISM), and including the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) outcomes. The research team, led by Multiple Principal Investigators (MPI), has expertise in psychiatry, HIV clinical care, implementation science, behavioral and social sciences, HIV clinical care, epidemiology, and mixed methods, and has a deep knowledge of HIV response and service delivery models in Zambia for marginalized populations, and experience implementing opioid use treatment both in the US, and in Kenya. We will also leverage the University of Maryland Baltimore’s decade of experience implementing MOUD and HIV programs in Kenya. Addressing the unmet needs of PWID is urgently needed to achieve and maintain HIV epidemic control; our findings will inform the implementation of integrated care models for PWID. Lessons learned from INSPIRE will help develop best practices for system-level approaches to improve OUD treatment and HIV prevention and treatment programs in both sub-Saharan Africa and the US.