HIV, Substance Use Disorder (SUD)
Conditions
Keywords
social networks, HIV, substance use disorder, HIV testing, HIV prevention, harm reduction, social stigma, programs, testing, treatment, mental health, community clinic, intervention, color, Chicago, drug abuse, addiction
Brief summary
This study aims to improve health care for people who may have HIV or substance use disorders by bringing two services to a large community health center in Chicago. First, the clinic will begin offering routine screening for substance use to all patients. Second, the study will offer a social network-based program that helps people identify friends or partners who may need support and link them to care. The goal is to help more people learn their HIV status, reduce HIV levels in the community, and connect people with substance use treatment when needed. The study will also look at how well these services can be added into everyday clinic practice and what is needed to keep them going over time.
Detailed description
This project will take place in a network of federally qualified health centers that serves communities in Chicago that experience some of the highest rates of new HIV infections. The study has two main parts: Routine Substance Use Screening and a Social Network Intervention (SNI). Routine screening at the clinics will introduce a consistent, standardized way to ask patients about substance use during regular visits. Patients who screen positive will be offered help, referrals, and follow-up services. The social network intervention asks patients to think about people in their social networks (such as partners, friends, or peers) who may have untreated HIV, may have fallen out of care, or may have substance use concerns. Participants will receive support and tools to help connect people in their network to HIV testing, care, and treatment or substance use services at these clinics. Together, these activities aim to: * Identify people who have HIV but are not in care * Reduce HIV viral load levels in the community * Identify people with substance use disorders and link them to treatment * Improve access to supportive services in the community The study will also examine how easy or hard it is for clinics to use these two strategies in everyday practice. Researchers will gather feedback from clinic staff and patients to understand what helps or gets in the way of using these services in the long term. The goal is to create a package of tools and processes that other clinics can adopt in the future.
Interventions
BEHAVIORALSubstance use disorder screening
Implement a routine SUD screening at the FQHC.
BEHAVIORALSocial network intervention
Social network intervention (SNI) to identify individuals who are viremic, have SUD, or both and link them to harm reduction and HIV continuum of care services. There are three main activities that make up the SNI: 1) recruiting, screening, and interviewing "index participants"; 2) training the index participants to recruit others; 3) screening and interviewing persons who present a valid recruitment voucher given to them by an index participant.
Sponsors
University of California, San Diego
Howard Brown Health Center
University of Chicago
National Institute on Drug Abuse (NIDA)
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Viral suppression and SUD reduction will be monitored via chart review and used to parameterize an agent-based model (ABM) examining the potential population-level impact of implementing the SUD screener and SNI across Chicago on the local HIV epidemic. Control data will consist of standard intake data on new patients and patients returning to care at HBH. Standard intake data will be collected corresponding to the same timeframe as the recruitment period for the SNI.
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Assigned male sex at birth * Has sex with men * Speaks English or Spanish
Exclusion criteria
* Institutionalized individuals * Women * Non-Hispanic whites
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Substance Use Disorder (SUD) Detection | Baseline through 24 months | The number and proportion of patients who screen positive for substance use disorder using the routine SUD screening tool (NIDA Quick Screen) compared with the number identified through existing electronic medical record (EMR) documentation. This outcome measures whether routine screening increases the detection of individuals with possible SUD. |
| Number of Individuals Identified as Viremic and/or Having SUD Through the Social Network Intervention (SNI) | Baseline through 24 months | The number of people identified through the Social Network Intervention who have unsuppressed HIV (viremia), substance use disorder, or both. This will be compared to a functional control group (new or re-engaged clinic patients during the same time period) to determine whether the SNI is more effective at finding high-priority individuals needing care. |
| Linkage to HIV Care or Substance Use Services | Baseline through 24 months | The proportion of individuals identified through SUD screening or the SNI who successfully link to harm reduction, HIV care, or substance use treatment services. This outcome assesses early engagement in care following identification. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Viral Suppression Among Individuals Identified Through Screening or SNI | Baseline through 24 months | The proportion of people identified with HIV who achieve viral suppression after being linked to care. This measures the downstream impact of improved identification and engagement. |
| Time to Linkage to HIV Care or Substance Use Services | Baseline through 24 months | The number of days from identification (via SUD screen or SNI) to the first attended HIV care appointment, harm reduction service, or substance use treatment visit. |
| Number of New HIV Diagnoses Identified Through the SNI | Baseline through 24 months | The number of individuals identified by SNI participants who test positive for HIV and were previously undiagnosed. |
| Substance Use Treatment Initiation | Baseline through 24 months | The proportion of people identified with SUD who initiate counseling, medication-assisted treatment, or other substance use services. |
| Re-engagement in HIV Care | Baseline through 24 months | The number and proportion of individuals previously out of care for ≥6 months who return for at least one HIV medical visit after identification. |
| Acceptability of SUD Screening and the SNI | Measured at Months 6, 12, 18, and 24 | Acceptability scores based on surveys and interviews with clinic staff and participants, assessing satisfaction, perceived burden, and overall fit within the clinical setting. |
| Feasibility of Implementing the SUD Screener and SNI | Baseline through 24 months | Assessment of whether the interventions can be carried out in the clinic as intended, measured by workflow fit, completion rates, and staff-reported ease of implementation. |
| Sustainability of Screening and SNI Workflows (EPIS: Sustainment Phase) | Measured at 24 months | Indicators of ongoing use of SUD screening and SNI processes without external study support, including continued staff utilization and workflow integration. |
Countries
United States
Contacts
CONTACTBritt Skaathun, PhD
CONTACTNicole Carter, MPH
PRINCIPAL_INVESTIGATORBritt Skaathun
University of California, San Diego
Outcome results
None listed