Mobile health strategies to support longitudinal engagement in harm reduction services

We will conduct a 5-year research project that aims to extend and enhance the delivery of comprehensive, community-based prevention services to hard-to-reach people who use opioids and/or stimulants, to reduce their risk of fatal and nonfatal overdose. The main objective of this research is to design, and pilot test a mobile health (mHealth) intervention comprised of a bundle of internet and mobile phone-based tools for reducing overdose risk. We will build upon a productive research partnership with an established, comprehensive community-based prevention services organization operating in 10 cities in Wisconsin to pursue 3 specific aims. First, using a prospective cohort study design and several innovative methods for capturing prevention service engagement, psychosocial variables, and behavioral outcomes, we will characterize the most important mechanisms through which prevention services influence overdose risk behaviors. Second, we will study the role of prevention service engagement in linking clients to other sources of health care and addiction treatment services, making novel use of linkages between administrative datasets in partnership with state government agencies. Third, we will convene a Community Leadership Team consisting of people who use opioids and/or stimulants and collaboratively synthesize our research findings to inform the development and implementation of an innovative strategy for engaging clients who face barriers to accessing prevention services. The community engagement activities will culminate in a single-arm pilot intervention trial that evaluates the feasibility and acceptability of a suite of internet and smartphone-based tools designed to improve access to overdose prevention resources, fill knowledge gaps, and deliver social support through connection to trusted peer networks. This approach will ensure people who use drugs have a real voice in the creation of programs designed to serve them. Our research will generate a robust understanding of the important mechanisms through which prevention services reduce overdose risk, and test promising strategies for extending their reach to under-served clients.