TechMPower: Advancing HIV/SUD Care and Service Delivery for People Involved in the Criminal Legal System

Columbia Univ New York Morningside, New York NY

Investigators

Abstract

HIV prevalence in correctional facilities in the US is about five times greater than in the general population. About 14% of people living with HIV (PLWH) experience incarceration every year, and 15% of those incarcerated do not know their HIV status. Over 50,000 people are incarcerated in New York state and 1-2% are estimated to be PLWH. An estimated 70-80% of US jail detainees have a substance use disorders (SUD) and are at high risk of relapse, overdose and HIV infection post-release. Intervening during incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though more robust HIV and SUD interventions are needed to improve care continuity. Increasing point-of-care rapid testing would maximize HIV detection and results receipt among people in jails and prepare them with essential knowledge and skills on SUD and HIV services post-release. TechMPower is a Regional Research Hub (RRH) and 2-phase, Hybrid Type II effectiveness/implementation study to evaluate the effectiveness of an intervention that bundles implementation strategies to increase delivery of HIV and SUD targeted evidence-based practices (EBPs) to prevent adverse HIV-related (new infection, untreated HIV) and SUD-related outcomes (fatal and non-fatal overdose) among a sample of individuals (n=1200 ) in six county jails in New York and New Jersey. In the first phase of this TechMPower study, we completed a pilot study to prepare for the phase two (R33) trial, informed by the PRISM/RE-AIM framework. Here, we successfully recruited 41 detained people in one NYS county jail and established and engaged a HEALing Communities Study coalition to implement the selected EBPs that act to increase: 1) HIV screening/testing via self-testing; 2) SUD screening, brief interview and referral to treatment (SBIRT); and 3) access to and uptake of biomedical HIV and SUD prevention and treatment (PrEP/PEP/ART); overdose education/naloxone distribution [OEND], opioid use disorder medication [MOUD]) delivered through 4) hybrid linkage (telehealth, face-to-face) to services via Navigation Enhanced Case Management (NCM). To optimize EBP delivery, TechMPower applies key implementation strategies including: a) data driven, multidisciplinary community coalitions and designated CLS workgroup; b) implementation teams led by champions; c) training in person-centered approaches for optimal service providers/organizations; and d) tech-mediated and hybrid trainings and service delivery. This study capitalizes on the investigators’ extensive expertise in conducting community-driven implementation studies, designing EBPs, and person-centered approaches to provide evidence for tech-mediated HIV and SUD service delivery integration in jails with linkages to community-based care.