A multidisciplinary approach to integrate HIV prevention services into clinical care settings for people with opioid use disorder

PROJECT SUMMARY Opioid use continues to be a public health crisis in the United States (US). An estimated 2.7 million people had opioid use disorder (OUD) with over 107,000 overdose deaths in 2022 in the US. OUD is also a major risk factor for HIV infection due to injection and high-risk sexual behaviors. Despite the higher risk of HIV, OUD patients have had very limited engagement with HIV prevention services, including HIV screening, HIV pre- exposure prophylaxis (PrEP), and medication for OUD (MOUD) services, which are highly effective in preventing HIV infection. Novel approaches are needed to explore how to engage people with OUD in HIV prevention services with the long-term goal of reducing HIV incidence. The integration of HIV prevention services into care setting (e.g. emergency departments, primary care, mental health clinics, and substance treatment centers) where people with OUD already seek care is promising. As the integration of HIV prevention services into care settings is complicated due to the individual-, social- and structural-level barriers, we will use innovation and multidisciplinary approaches to achieve this goal. In this proposal, we will conduct a systematic assessment of healthcare utilization in general, HIV prevention services, and MOUD using the All Payers Claims Database (APCD) and State Emergency Department Database (SEDD) (specific aim (SA) 1), use the Evidence-Based Quality Improvement (EBQI) - a collaborative stakeholder-guided intervention/strategy development process to determine the optimal care setting and identify implementation strategies of integrating HIV prevention services and MOUD (SA 2), and then test their effects on reducing HIV incidence at the population level using agent-based modeling (SA3). This innovative study will identify care settings to maximum HIV prevention efforts, test multiple promising implementation strategies, and identify the most effective implementation strategy, which is ready for real-world implementation.