Health care centers in 5 US cities are participating in a study launched by the HIV Prevention Trials Network to determine if mobile health units can improve HIV and substance use treatment and prevention among individuals with opioid use disorder.
The goal of these units, which deliver integrated health services, is to prevent overdoses and deaths and to provide antiretroviral therapy or pre-exposure prophylaxis against HIV in people who inject opioids. Individuals are tested for other sexually-transmitted infections (STI) and provided medications for HIV/STI treatment and prevention. The program includes testing and referrals for other health care needs, including routine vaccinations and other primary care and harm reduction services. Following the first 26 weeks of the trial intervention, participants will be transitioned to other community-based services to address their health care needs.
The trial will enroll about 860 individuals who inject drugs but are not receiving medications for opioid use disorder. They will be randomly assigned to receive the full range of mobile medical services or to a control arm for 26 weeks. Participants in the control arm will only receive peer health navigation that connects them to services available at brick-and-mortar locations in the community. Investigators will compare outcomes between the 2 study arms.
The Centers for Disease Control and Prevention (CDC) reports that in 2019 there were 70,630 drug overdose deaths in the United States. Synthetic opioids are the main contributor to overdose deaths, resulting in 49,860 overdose deaths in 2019 (70.6% of all drug overdose deaths). Individuals who inject drugs risk both overdose and HIV transmission and acquisition. They often face multiple barriers to care, including access to treatment.
The University of Texas Health Science Center in Houston is one of the participating centers. Trial investigator James Langabeer, PhD, a professor of biomedical informatics, emergency medicine, and public health at the center, said the effort is aimed at meeting people with opioid use disorder where they are and with health services that are judgment-free. “There is a well-documented gap in treatment for certain vulnerable populations, especially those who inject drugs and could be at increased risk for acquiring HIV, Dr Langabeer said. “The use of a mobile van to quickly provide care to geographic hotspots across the city could help to reduce wait times for those needing treatment.”
Eligible participants include individuals aged 18 to 60 years with opioid use disorder who inject drugs, are at risk of acquiring HIV or are living with HIV, and willing to start opioid use disorder treatment. “In Houston and elsewhere, the epidemic involving opioid use disorder has skyrocketed. We see a troubling pattern of increasing overdoses and deaths attributed to not rapidly finding and treating those in need. We see this as a potential strategy for combatting the epidemic,” Dr Langabeer said.
The trial also is being conducted at centers in Los Angeles, New York, Philadelphia, and Washington, DC. It is sponsored by the National Institute of Allergy and Infectious Diseases, with funding from the National Institute of Drug Abuse.