Innovations in Implementing Medications for Opioid Use Disorder for HIV Prevention in Probation Settings in Eastern Europe

Yale University, New Haven CT

Investigators

Abstract

This K01 seeks support for formal coursework, seminars, interdisciplinary mentorship, and research in Eastern Europe to expand the skills of a sociologist who has been academically productive in examining the social production of HIV risk in prisons but now aims to shift their career toward tailoring implementation strategies for HIV prevention among people who use drugs. Dr. Azbel seeks to broaden their training to emerge as an independent researcher who can leverage newly acquired skills in ethnography, implementation science (both theory and real-world experience), and mixed methods research and apply them to a new setting, probation, which aligns with decarceration goals. They aim to shift their research trajectory from retrospectively unpacking why an intervention did not work as expected (using qualitative interviews) to prospectively refining strategies to improve interventions (using quantitative and ethnography). The training will support Dr. Azbel's two proposed research projects, which use the EPIS framework to understand the influence of the inner and outer contexts on the successful implementation of a screening-engagement-treatment (SET) strategy for opioid agonist therapy (OAT) scale-up. The projects will occur in probation in Georgia and Moldova, two distinct epidemiological, social, and geopolitical contexts. The conflicting roles of upholding public health and public safety strain the complex and understudied officer-client relationship, which research has shown to be crucial for the successful implementation of evidence-based practices. The core of these projects will be to refine strategies to align probation officers’ primary focus (public safety by reducing crime) with their evolution toward public health mandates (to reduce transmission of HIV through facilitating clients receiving OAT). Project 1.1, guided by the socioecological model, will examine the barriers and facilitators within the inner context (officers and clients) to implementing SET procedures to promote OAT scale-up using mixed methods, including structured surveys and nominal group technique (NGT). Project 1.2 will use ethnographic methods to explore the dynamic interrelations of the inner (client, officer) and outer (probation leadership, OAT clinics) contexts as SET is implemented and process changes are introduced via NIATx (a bundle of implementation tools). The candidate will test the hypothesis that NIATx improves collaboration and trust between probation staff, leadership, and clients, particularly as their goals align as OAT improves individual health and reduces crime. These research aims will be enhanced through the candidate getting certified as a NIATx coach where they will coach change teams in probation in Kyrgyzstan. As probation services expand, including in the U.S., such analysis can be leveraged to expand OAT as HIV prevention in ways that promote decarceration and are responsive to local needs and contextual differences. The candidate’s long-term career goal is to become an independent global health investigator focused on implementing culturally attuned HIV prevention interventions that target criminal justice populations, especially where decarceration efforts are involved.