eHealth Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: A Pilot Randomized Trial Study Protocol (Preprint)

Abstract

Young adults (YA) represent 41.9% of the adults incarcerated in the US and have the highest HIV incidence rates nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail, yet peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people.

This manuscript describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct.

The three aims of this study are to: 1) adapt an existing, evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link YA (18 to 29 years) surveilled by the criminal legal system to substance use and PrEP services; 2) refine and test the intervention with CLI-YA; and 3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YA (n~24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (N=10), the Navigator (N=1), and systems partners (N=4) will assess intervention acceptability and suggestions for improvement. A Community of Practice, a group of systems partners with an interest in working towards solutions to common problems, will inform each phase of the study.

The primary outcomes of the formative work are the adaptation of an existing navigator model and the codevelopment of the proposed technology for eHealth enhancement. The open pilot’s primary outcome is qualitative feedback to assess appropriateness and satisfaction. Results will be used to refine the intervention for pilot testing in Aim 3. Primary outcomes of Aim 3 are linkage to substance use and PrEP services. Because PrEP and substance use treatment linkage are a process, we will also explore pre-linkage (e.g., navigator satisfaction) and downstream outcomes (e.g., PrEP initiation, adherence, substance use treatment continuing of care) in an exploratory fashion.

This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YA. Results will contribute to the development and testing of a future multi-level randomized controlled trial.

We are in the first year of the project and our pilot data are informing the final intervention content and structure, so we have yet to solidify trial details and register our trial.