NOTRE: optimizing long-acting pre-exposure prophylaxis and medications for opioid use disorder interventions in carceral settings

Co-occurring substance use and HIV risk among individuals in correctional settings presents a significant public health challenge. Approximately 17% of incarcerated individuals have an opioid use disorder (OUD), and HIV prevalence is notably higher than in the general population. Evidence-based medical interventions—such as pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD), including buprenorphine—are available but remain underutilized in these environments. Long-acting injectable (LAI) formulations of both PrEP and buprenorphine, recently approved by the FDA, offer new opportunities for improving treatment continuity and outcomes. This project proposes a hybrid implementation-effectiveness type 2 study to evaluate a co-packaged LAI PrEP + buprenorphine (XR-B) intervention in correctional and post-release settings in Maryland and Washington, DC. Specific objectives include: (1) developing a protocol for LAI PrEP + XR-B delivery; (2) evaluating implementation facilitation strategies; and (3) comparing the effectiveness of LAI PrEP + XR-B to oral PrEP + sublingual buprenorphine (SL-B). The long-term goal is to inform scalable, evidence-based practices for improving health outcomes in high-need populations.