Addressing Risk Through Community Treatment for Infectious Disease and Opioid Use Disorder Now Among Justice-Involved Populations (ACTION)

Community reentry from incarceration represents a critical opportunity to link at-risk individuals to vital HIV prevention and treatment and opioid use disorder (OUD) services. Thus, the ACTION study specifically focuses on screening, linkage, and service adherence for these individuals along the treatment and prevention service cascades of care. This study is a 5-year, multisite research project that engages community partners and examines the effect of patient navigation (PN) versus mobile health units (MHU) on HIV, substance use, and related outcomes in communities in Connecticut (New London and Windham/Tolland Counties) and Texas (Tarrant and Dallas Counties). Specific aims include the following.

Aim 1 (Intervention Effectiveness) is to compare the effectiveness of PN vs. MHU service delivery on outcomes such as time to PrEP/ART medication following release from custody. Secondary outcomes focusing on the continuum of PrEP and HIV care outcomes and OUD and substance use disorder (SUD) diagnoses will also be examined.

Aim 2 (Implementation) is to evaluate PN and MHU feasibility, acceptability, sustainment, and costs. Barriers to service access across the community provider spectrum will be assessed as well.

ACTION includes a preliminary community needs assessment in each of the target communities followed by a randomized controlled trial (RCT) designed to recruit individuals with identified risk factors who are being released to the participating communities. Participants will be randomized to either: (a) the PN condition where patient navigators will link study participants to community-based services agencies, providing participants with access to PrEP/ART and medications for opioid use disorder (MOUD); or (b) the MHU condition where participants will be linked to a MHU directly providing or referring to PrEP/ART, MOUD, and/or harm reduction services within their community.

The project is led by highly experienced Multiple PIs at TCU, Yale, and UTSW and includes partnerships with service provider leaders in the participating communities. ACTION represents the opportunity to engage in a community-wide effort focused on addressing gaps along the service/prevention cascade of care for the target population, with the primary goal being the improvement of linkage to HIV/MOUD and related services for justice-involved individuals.