A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Laramie R. Smith, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA. laramie@ucsd.edu.
Amaya Perez-Brumer, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Melanie Nicholls, School of Social Work, San Diego State University, San Diego, USA.
Jayla Harris, HIV Prevention Trials Network, Family Health International 360, Durham, USA.
Qiana Allen, UTHealth Houston McGovern School of Medicine, Houston, USA.
Alan Padilla, Columbia University, ICAP, Mailman School of Public Health, New York, USA.
Autumn Yates, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Eliza Samore, Center for Behavioral and Addiction Medicine at UCLA, Los Angeles, USA.
Rebecca Kennedy, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Irene Kuo, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Jordan E. Lake, UTHealth Houston McGovern School of Medicine, Houston, USA.
Cecile Denis, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA.
David Goodman-Meza, Division of Infectious Diseases at UCLA, Los Angeles, USA.
Peter Davidson, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Steve Shoptaw, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA.
Nabila El-Bassel, School of Social Work, Columbia University, New York, USA.

Document Type

Journal Article

Publication Date

6-3-2024

Journal

Implementation science : IS

Volume

19

Issue

1

DOI

10.1186/s13012-024-01363-x

Keywords

Complex interventions; HIV prevention; Health equity; Implementation science; Integrated care; Mobile health; People who inject drugs; Practical Robust Implementation Sustainability Model (PRISM)

Abstract

BACKGROUND: HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. METHODS: We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. RESULTS: Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. CONCLUSIONS: Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. TRIAL REGISTRATION: ClincalTrials.gov, Registration Number: NCT04804072 . Registered 18 February 2021.

Department

Epidemiology

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