Massachusetts HIV and Justice-Involved Populations Research Network

PROJECT SUMMARY A major driver of the U.S. HIV epidemic is inadequate access to HIV prevention and care in the criminal legal system. The End HIV Epidemic (EHE) Toolkit recommends that jails offer low-barrier access to HIV testing, treatment, and prevention to people who inject opioids, but many justice-involved people with opioid use disorder (OUD) do not know their HIV status and few access medications to prevent HIV (pre-exposure prophylaxis, PrEP). Suffolk County, the only EHE-designated jurisdiction in Massachusetts (MA), had a recent HIV outbreak, occurring in formerly incarcerated people with OUD, that disproportionately impacted three geographically and racially distinct communities (Boston, Chelsea, Revere). Improvements were made to increase carceral HIV prevention and care, but one year into implementation only about 10% were HIV tested and few were initiated on PrEP. MA Medicaid now authorizes coverage of HIV care before, upon, and following release from incarceration, but HIV care is not well-integrated with the jails’ existing medications for opioid use disorder (MOUD) program and there are gaps between jails and community healthcare. The Massachusetts HIV/Justice Research Network proposes to partner with the Suffolk jail system and community treatment partners to conduct a formative evaluation and pilot (R61, Aim 1) and type 2 hybrid implementation- effectiveness study (R33, Aims 2-4) of a multi-pronged intervention to increase HIV testing and PrEP linkage called ID-TOUCH (ID Testing OUtreach in Carceral Hubs). We will (1) Perform a formative evaluation of HIV care gaps and opportunities in Suffolk jails, using (1a) stakeholder engagement to co-design ID-TOUCH, (1b) existing administrative data to identify touchpoints for HIV care, focusing on differential barriers among incarcerated people who were and were not treated with MOUD, and (1c) a pilot-trial of ID-TOUCH, measuring changes in HIV testing, feasibility and acceptability, and self-reported patient outcomes. (2) Conduct a longitudinal treatment outcome study comparing outcomes of individuals released from Suffolk jails (a) during ID-TOUCH implementation, (b) before implementation, and (c) in relation to a nearby comparable jail system (contemporaneous control site) using the MA Public Health Data Warehouse, a collection of two dozen linked state administrative data sets, to examine HIV testing and post-release linkage to PrEP or HIV treatment. (3) Conduct an implementation study of ID-TOUCH to understand contextual factors that facilitate and impede delivery of HIV care in jail and community care coordination, and best practice strategies that optimize HIV care. (4) Estimate the cost of implementing and sustaining ID-TOUCH, and assess its economic value, relative to usual care, from healthcare sector, state-policymaker, and societal perspectives. The Massachusetts HIV/Justice Research Network, with the MA Department of Public Health, Suffolk jails, and community treatment partners, has the experience and expertise to fulfill the study aims. This study’s insights will inform the development of new treatment options to end the HIV epidemic in jail populations.