TechMPower: Advancing HIV/SUD Care and Service Delivery for People in Re-entry

Summary

The goal of this clinical study in one NY county is to pilot and refine implementation strategies aimed at improving delivery and uptake of evidence-based practices (EBPs) for HIV prevention/treatment and substance use disorder (SUD) care among incarcerated individuals approaching release with or at risk for HIV and SUD.

The main questions it aims to answer are:

1. How feasible and acceptable are the TechMPower implementation strategies (community coalition workgroups, multidisciplinary implementation team with champion, and tech-mediated training/service delivery with peer navigation) in real-world carceral and reentry settings?
2. To what extent do these strategies improve delivery and uptake of HIV testing with self-testing (HST), pre-exposure prophylaxis (PrEP)/antiretroviral treatment (ART), medications for opioids use disorder (MOUD), and overdose education and naloxone distribution (OEND)?
3. What are the preliminary cost estimates for the implementation strategies and EBPs to inform the larger trial to follow in NY and NJ?
4. What are the preliminary impacts on individual-level outcomes such as HIV testing, linkage to care, and SUD treatment initiation?

Our specific aims for the Phase I protocol presented here is conducted in one county (Ulster County) with a sample (n=50) of detained (prisoners) in their county jail are presented here:

* R61 \| Aim 1: Evaluate \\ preliminary effectiveness of TechMPower, using mixed methods and a pre-/post-evaluation design, on increasing reach of the EBPs resulting in the following outcomes: (1) SUD and HIV screenings (pre-/post-release); and (2) linkage to SUD prevention/care (MOUD, OEND); and (3) linkage to HIV prevention/care (applying a status-neutral approach) with community service providers post-release. (Effectiveness).
* R61 \| Aim 2: Identify how adoption/feasibility, implementation/fidelity and sustainability/maintenance of TechMPower may impact effectiveness of TechMPower outcomes as described in Aim 1 in one (Ulster County) jail using surveys of Implementation Team, jail staff and other key stakeholders. (Implementation)
* R61 \| Aim 3: Use implementation mapping to adapt implementation strategies for R33 phase. (Implementation)

Conditions

• HIV (Human Immunodeficiency Virus)
• Substance Abuse Disorder

Interventions

BEHAVIORAL

Community Coalition CLS Workgroup/Network of Providers

Community Coalition/Network of Providers TechMPower forms the foundation of community engagement in this approach, with membership including PLWH and SUD, sheriffs, within-jail staff, community service providers or other partners who are able to advance the adoption of EBPs within jail and service settings. All coalitions are trained and prepared to drive a planning process at the local level for efficient identification and allocation of resources needed to link people from CLS to a network of community providers for HIV and SUD care and retention. Community coalitions integrate evidence-based (ERIC) strategies: Build coalition; Promote network weaving; Identify/train champions; Conduct consensus discussions that support needed services.

BEHAVIORAL

Tech-mediated Training and Service Delivery

Researchers will train all staff, healthcare providers and peer navigators to recognize and reduce stigma in CLS and healthcare settings using a training program informed by MPI Frye and colleagues in the CHHANGE (MH102182-01) intervention, which developed an anti-intersectional stigma training program for CBOs and offers comprehensive training to healthcare and social service organizations. Additionally, researchers will train staff and support protocol enhancements as needed to utilize tech mediated service delivery for NCM in-reach and services coordination in the community. These integrate 5 evidence-based (ERIC) implementation strategies: promote consultation; provide clinical/technical supervision; centralize technical assistance; change physical structure and equipment.

BEHAVIORAL

Multidisciplinary Implementation Team with Champion

The multidisciplinary Implementation Team will be comprised of a correctional health nurse, social worker and discharge planner or counselor and corrections officer from the jail. A representative from the community coalition and peer and case manager from NCM will join the team using a tech-mediated platform for conducting the training and for on-going weekly case conferencing addressing system and client level barriers and service planning. The role of the champion from the correctional setting will be to convene meetings focused on fidelity to the intervention components, engagement in shared problem-solving and mediation of administrative issues that may inhibit effective implementation of TechMPower. The champion and implementation team may request technical assistance (TA) or implementation facilitation at any point during implementation. This TA may be provided by the investigative team or outside providers from federal programs.

BEHAVIORAL

Tech-mediated Peer Navigation Enhanced Case management (NCM)

Navigation-Enhanced Case Management (NCM) uses Project START, a CDC best evidence intervention as its HIV risk reduction framework. Prior to release, a case manager and peer navigator via telehealth and in-person provide discharge planning and patient education and serves as a liaison to the courts. After release, patient navigators facilitate reentry into community care and provide referrals to HIV medical and SUD care as appropriate (e.g., ART, PrEP, MOUD) and assistance with food, housing, transportation, employment, substance dependence, mental health treatment, and legal issues. TechMPower planned to enhance tracking of linkage during NCM services by integrating reporting along with a web-based platform that tracks assignment of providers and peers and follows for 6 months to capture PRISM linkage and retention in MOUD, HIV and ancillary care.

Sponsors & Collaborators

• National Institute on Drug Abuse (NIDA)

  collaborator NIH

• University of Pennsylvania

  collaborator OTHER

• Columbia University

  lead OTHER

Principal Investigators

• Timothy L Hunt, MSW, PhD · Columbia University

• Victoria A Frye, MPH, DrPH · Columbia University

• Nabila El-Bassel, PhD · Columbia University

Study Design

Allocation

NA

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-11-22

Primary Completion

2025-09-30

Completion

2025-09-30

Countries

• United States

Study Locations