Community-Based, Client-Centered Prevention Homes to Address the Rural Opioid Epidemic- Aim 3

Not Applicable

Completed

Conditions: Opioid-use Disorder
Drug Use Disorders
Hepatitis C
Harm Reduction

Interventions: Other: Community-Based, Client-Centered Prevention Home

Registration Number: NCT04268173

Lead Sponsor: University of Wisconsin, Madison

Brief Summary: The goal of this study was to effectively use a client-centered community-based intervention to engage people who inject drugs (PWIDs) in healthcare that helps reduce risky behaviors and lower infectious disease risks. Participants in the intervention group of this study received a 12-week intensive multilevel harm reduction case-management intervention at three rural Vivent Health offices. Service coordination aimed to reduce human immunodeficiency virus (HIV), hepatitis C virus (HCV), and overdose risks in PWIDs. Prevention Navigators (PNs) at each office helped to coordinate referrals to reduce substance use disorder and increase engagement in the substance use disorder care cascades.

Detailed Description: This project was conducted by an experienced, interdisciplinary team working across academic, public health, and non-government sectors. The main community partner Vivent Health, formerly known as the AIDS Resource Center of Wisconsin (ARCW), is a unique, state-wide organization that provides harm reduction services, including syringe services and confidential HIV and HCV testing, to clients at 10 fixed sites and numerous mobile units reaching all 72 Wisconsin counties. Based on the investigators' preliminary studies and prior collaborations, the investigators selected 6 counties in rural Wisconsin. The Client-Centered Prevention Home intervention model was implemented at 3 Vivent Health field offices in 3 of these counties, and 3 other counties served as "usual services," or control sites. Participants in the intervention underwent a 12-week intensive multilevel harm reduction case-management intervention geared towards coordinating referrals to reduce substance use disorder and increase engagement in the substance use disorder care cascades, and reduce vulnerability to HIV, STIs, and HCV and increase in engagement in the HIV, STI, and HCV care cascades. Participants in the intervention arm worked with Prevention Navigators to undergo a risk assessment and identify problems and create goals that they want to achieve. Each session after that was used to review the needs assessment and goals. During their last meeting, participants and prevention navigators developed a discharge plan that will enable the participants to work on their goals on their own. Participants at all six sites were offered rapid testing for HIV, HCV, and STIs, and fill out survey questionnaires to evaluate risk behaviors, intervention effectiveness, and general needs of the communities.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 343

Inclusion Criteria

has injected drugs in the past 30 days, resides in Wisconsin, over 18 years of age
able to read and write in English

Exclusion Criteria

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Prevention Navigation	Community-Based, Client-Centered Prevention Home	Participants enrolled in this arm will receive a 12-week community-based, client-centered, prevention intervention.

Primary Outcome Measures

Name	Time	Method
Change in the Risk of HIV as Assessed by Risky Behavior Frequencies	Pre-intervention, post intervention (3 months)	Participants were asked to gauge frequency of safe injection behaviors that reduce the risk of HIV. Participants will be asked how many times in the last 30 days they have practiced these behaviors. "In the last 3 months, how often have you shared needles with someone else, used a syringe more than once, used equipment you knew wasn't clean, or received equipment from a potentially unsafe source?" Responses were coded 0="never" and 1="at least once"
Change in the Addiction Treatment Accessibility and Utilization as Assessed by Change in Frequency of "Yes" Answers	Pre-intervention, post intervention (3 months)	Following questions will be asked with yes or no answers. In the past 3 months, have you gotten buprenorphine maintenance medication-like Suboxone or Subutex-from a doctor or program? Responses were coded as 0 = "No" and 1 = "Yes." Summary statistics presented as "mean" below represent the proportion responding yes.
Change in the Addiction Treatment Accessibility and Utilization as Assessed by Change in Likert Scale	Pre-intervention, post intervention (3 months)	The following question was asked on a scale of 0 to 4, where 0=strongly disagree and 4=strongly agree: If I wanted to start medical treatment for opioid or heroin addiction, I could easily get buprenorphine or Suboxone or Subutex. The outcome is represented as the mean response in each intervention group (min 0, max 4)
Change in the Risk of HIV as Assessed by Change in Likert Scale	Pre-intervention, post intervention (3 months)	Following questions will be asked to gauge ease of accessing clean injecting equipment to assess how risky the participants behaviors are in relation to HIV transmission. "It's easy for me to get new, clean syringes or needles." Questions will be answered on a scale of 0 to 4, with 0=strongly disagree and 4=strongly agree. An increase in the Likert scale among intervention participants is associated with increased access to HIV prevention compared to the controls.
Change in the Risk of Drug Overdose as Assessed by Change in Likert Scale	Pre-intervention, post intervention (3 months)	Following question will be asked on a scale of 0 to 4, where 0=strongly disagree and 4=strongly agree "If I wanted the overdose reversal drug naloxone or Narcan, I could easily get it."