Document text
Principal Investigator: Elizabeth A. Evans
Organization: TUFTS MEDICAL CENTER
Fiscal Year: 2024
Award: $392,637
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY
A major driver of the U.S. HIV epidemic is inadequate access to HIV prevention and care in the criminal legal
system. The End HIV Epidemic (EHE) Toolkit recommends that jails offer low-barrier access to HIV testing,
treatment, and prevention to people who inject opioids, but many justice-involved people with opioid use
disorder (OUD) do not know their HIV status and few access medications to prevent HIV (pre-exposure
prophylaxis, PrEP). Suffolk County, the only EHE-designated jurisdiction in Massachusetts (MA), had a recent
HIV outbreak, occurring in formerly incarcerated people with OUD, that disproportionately impacted three
geographically and racially distinct communities (Boston, Chelsea, Revere). Improvements were made to
increase carceral HIV prevention and care, but one year into implementation only about 10% were HIV tested
and few were initiated on PrEP. MA Medicaid now authorizes coverage of HIV care before, upon, and following
release from incarceration, but HIV care is not well-integrated with the jails’ existing medications for opioid use
disorder (MOUD) program and there are gaps between jails and community healthcare. The Massachusetts
HIV/Justice Research Network proposes to partner with the Suffolk jail system and community treatment
partners to conduct a formative evaluation and pilot (R61, Aim 1) and type 2 hybrid implementation-
effectiveness study (R33, Aims 2-4) of a multi-pronged intervention to increase HIV testing and PrEP linkage
called ID-TOUCH (ID Testing OUtreach in Carceral Hubs). We will (1) Perform a formative evaluation of HIV
care gaps and opportunities in Suffolk jails, using (1a) stakeholder engagement to co-design ID-TOUCH, (1b)
existing administrative data to identify touchpoints for HIV care, focusing on differential barriers among
incarcerated people who were and were not treated with MOUD, and (1c) a pilot-trial of ID-TOUCH, measuring
changes in HIV testing, feasibility and acceptability, and self-reported patient outcomes. (2) Conduct a
longitudinal treatment outcome study comparing outcomes of individuals released from Suffolk jails (a) during
ID-TOUCH implementation, (b) before implementation, and (c) in relation to a nearby comparable jail system
(contemporaneous control site) using the MA Public Health Data Warehouse, a collection of two dozen linked
state administrative data sets, to examine HIV testing and post-release linkage to PrEP or HIV treatment. (3)
Conduct an implementation study of ID-TOUCH to understand contextual factors that facilitate and impede
delivery of HIV care in jail and community care coordination, and best practice strategies that optimize HIV
care. (4) Estimate the cost of implementing and sustaining ID-TOUCH, and assess its economic value, relative
to usual care, from healthcare sector, state-policymaker, and societal perspectives. The Massachusetts
HIV/Justice Research Network, with the MA Department of Public Health, Suffolk jails, and community
treatment partners, has the experience and expertise to fulfill the study aims. This study’s insights will inform
the development of new treatment options to end the HIV epidemic in jail populations.
Terms: <AIDS Virus><AIDS prevention><AIDS test><AIDS/HIV test><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Application Context><Authorization><Authorization documentation><Boston><Caring><Collection><Communication Methods><Communities><Community Health Care><Community Healthcare><Community Services><Continuity of Care><Continuity of Patient Care><Continuum of Care><County><Data><Data Set><Development><Diagnostic Services><Disease Outbreaks><Drugs><Epidemic><Event><Foundations><Future><Geography><Goals><HIV><HIV Prevention><HIV Seronegativities><HIV Seronegativity><HIV negative><HIV test><HIV-1 test><HIV-2 test><HIV/AIDS prevention><HTLV-III Seronegativities><HTLV-III Seronegativity><Health Care Costs><Health Care Sector><Health Costs><Health Status><Healthcare><Healthcare Costs><Human Immunodeficiency Viruses><Human immunodeficiency virus test><Imprisonment><Individual><Infection><Intervention><Intervention Strategies><Jail><Justice><LAV-HTLV-III><Legal><Legal system><Level of Health><Link><Lived experience><Lived experiences><Lymphadenopathy-Associated Virus><Massachusetts><Measures><Medicaid><Medication><Methods><Modality><Modeling><Opiates><Opioid><Outbreaks><Outcome><Outcome Measure><Outcome Study><Overdose><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Patient Self-Report><Penetration><Permission><Persons><Pharmaceutical Preparations><Phase><Policy Maker><Population><Population Research><Population-based research><Population-level research><PrEP><Prevention><Public Health><Race><Races><Recommendation><Research><Research Resources><Resources><Self-Report><Site><System><Testing><Treatment outcome><Virus-HIV><acceptability and feasibility><care as usual><care coordination><community care><community partners><community-based partners><contextual factors><coordinating care><cost effective><cost estimate><cost estimation><data warehouse><design><designing><developmental><diagnosis service><drug/agent><economic value><effectiveness/implementation hybrid study><effectiveness/implementation study><experience><formative assessment><formative evaluation><health care><health care service><health level><healthcare service><implementation intervention><implementation study><improved><incarcerated><incarceration><insight><interventional strategy><measurable outcome><medication for opioid use disorder><monetary value><mortality><opiate use disorder><opioid use disorder><outcome measurement><outreach><outreach program><pilot test><pilot trial><pre-exposure prophylaxis><prevent><preventing><prevention service><primary outcome><process improvement><programs><public health relevance><racial><racial background><racial origin><reincarceration><response><safety net><secondary outcome><success><treatment as usual><treatment services><uptake><usual care>