An Integrated HIV/OEND Peer Navigation Intervention for Latinx People Who Use and Sell Drugs (PWUSD)

Drug overdoses, HIV transmission, and other substance use-related co-morbidities are soaring among people who use drugs (PWUD) in the US. Among the demographic sectors who continue to be overlooked by risk reduction programming, one key population is comprised of people who use and sell drugs (PWUSD). People who sell drugs are not typically engaged by public health interventions and have limited access to health services despite often suffering from substance use disorder (SUD) themselves. This R34 study seeks to address health disparities to accessing HIV, overdose prevention, and other public health services by developing and piloting an integrated HIV/overdose education and naloxone distribution (OEND) peer navigation intervention targeting PWUSD in Kensington, Philadelphia. The proposed pilot intervention will train 45 PWUSD in the use and distribution of naloxone and will link them to PrEP via peer navigation. In neighborhoods with large, open-air narcotics markets such as Kensington, PWUSD are strategic participants because they are the only group who interact continuously with other people who sell drugs, PWUD, and surrounding local residents who do not participate in the narcotics economy. They interact sexually with all these populations and also often use drugs and are at risk of HIV. Research by the investigative team has shown that Kensington drug suppliers are part of demographic groups who also control most of the largest retail drug markets in the US Northeast, mid-Atlantic, and Rustbelt regions in addition to Southern California and the Southwest/Mexican borderlands. Incorporating these PWUSD into health services programming consequently may considerably expand access to risk reduction services in the US, transforming narcotics retail endpoints into sites of opportunity for public health intervention. In this pilot study, we will randomize 90 HIV-negative PWUSD (20% female) to a 4-session experimental arm with peer navigation to PrEP or a time- and attention-controlled standard HIV/OEND one-session training and follow them for 12 weeks. The study will assess whether receiving peer navigation to PrEP and peer training on naloxone significantly improves health outcomes among participating PWUSD compared to receiving basic training on locally-available services alone. The primary outcomes are: (1) PrEP uptake and adherence and (2) increased carrying of naloxone and naloxone competency. The study’s findings will inform an R01 application for a full-scale efficacy trial testing this intervention at a larger scale, and will have implications for research with PWUSD throughout the United States.