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Principal Investigator: LEO BELETSKY
Organization: JOHNS HOPKINS UNIVERSITY
Fiscal Year: 2024
Award: $900,881
Funding agency: National Institute on Drug Abuse
The overall goal of this two-phase (R61/R33) study is to build capacity in the behavioral health workforce,
consisting primarily of medications for opioid use disorder (MOUD) staff, by training them to deliver an
evidence-based police education program to reduce HIV risk among people who use drugs (PWUD). A well
characterized evidence-base indicates certain policing practices, such as arrest, can elevate drug-related harm
by preventing access to life-saving medications and increasing overdose. Despite police officers having wide
discretion when responding to drug-related offenses, arrest and incarceration rates of PWUD remain high,
which in turn increase risk of syringe sharing, HIV, HCV, and overdose. This study will help fill a critical gap in
the science to examine the impact and scalability of a structural level HIV prevention intervention that shifts
policing away from arrest and toward referral to evidence-based MOUD. The Safety and Health Integration in
the Enforcement of Laws on Drugs (SHIELD) is a police education program that has been implemented in
numerous U.S. jurisdictions that focuses on reducing occupational risks and burnout among police, and task-
shifting to increase referrals to essential services for PWUD, such as MOUD. Thus far, delivery of SHIELD has
relied on a specialized academic team limiting its scalability. In this study, we will move SHIELD into the hands
of the behavioral health workforce and implement “SHIELD 2.0” in a region of Appalachia that has been hard
hit by overlapping epidemics of overdose and blood-borne virus transmission. Evaluating the implementation
processes and effectiveness of this approach will be a critical step towards SHIELD 2.0 having broader
implementation and population impact. We will leverage the infrastructure of an ongoing cohort of
approximately 500 PWUD (“SNAP” cohort, R01DA033862, PI: Havens) in Kentucky to externally validate
SHIELD 2.0. In the first year of this study (R61 phase), we will rapidly assess BHW acceptability and readiness
to deliver a structural HIV prevention intervention (SHIELD 2.0) to police (Aim 1) and adapt and pilot the
SHIELD 2.0 intervention to assess its feasibility and acceptability (Aim 2). In the R33 phase, we will then
conduct a Type 2 hybrid implementation-effectiveness study to evaluate SHIELD 2.0 implementation
processes and outcomes (Aim 3), and determine the effectiveness and cost-effectiveness of SHIELD 2.0 on
referral to MOUD services and drug-related arrest on blood-borne virus transmission and overdose (Aim 4).
Given the increasingly recognized role of the justice system as a driver of HIV and other drug-related harms,
these aims are highly responsive to RFA-DA-24-015 “Ending the HIV Epidemic: Focus on Justice Populations
with SUD”. We expect findings from this study to be high-impact and would visibly transform policing to reduce
structural HIV risk. Further, enhancing the role of justice agencies to reduce HIV risk through enhancing
access to HIV prevention services, such as MOUD, is a major interagency priority of the Department of Health
and Human Services, Department of Justice, and the Office of National AIDS Policy.
Terms: <AIDS><AIDS Virus><AIDS prevention><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Address><Appalachia><Appalachian><Appalachian Region><Area><Assess implementation><Behavior assessment><Collaborations><Communities><County><Data><Department of Health and Human Services><Disease Outbreaks><Drug Therapy><Drug user><Drugs><Economic Models><Education><Educational aspects><Effectiveness><Epidemic><Evaluation><Evidence based intervention><Funding><Goals><HCV><HIV><HIV Infections><HIV Prevention><HIV risk><HIV/AIDS prevention><HTLV-III Infections><HTLV-III-LAV Infections><Hand><Harm Minimization><Harm Reduction><Health><Health Care Providers><Health Personnel><Health Services><Healthcare Providers><Healthcare worker><Hepatitis C virus><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><Implementation assessment><Imprisonment><Incidence><Infrastructure><Interruption><Intervention><Intervention Strategies><Justice><Kentucky><Knowledge><LAV-HTLV-III><Law Enforcement><Letters><Life><Light><Long-term cohort><Longitudinal cohort><Longterm cohort><Lymphadenopathy-Associated Virus><Medication><Mexico><Modeling><NIDA><National Institute of Drug Abuse><National Institute on Drug Abuse><Needle Sharing><Needle-Exchange Programs><Occupational><Occupational Safety><Outbreaks><Outcome><Overdose><PWUD><Pharmaceutical Preparations><Pharmacotherapy><Phase><Photoradiation><Police><Police officer><Policies><Population><Preparedness><Preventative intervention><Public Health><Readiness><Reporting><Research><Risk><Risk Factors><Role><Rural><Safety><Science><Services><Source><Specialty><Substance Use Disorder><Syringe Sharing><Syringe-Exchange Programs><System><Temporal trend><Time trend><Trainers Training><Training><Translating><Transmission><Trends over time><United States Department of Health and Human Services><United States Dept. of Health and Human Services><Virus-HIV><acceptability and feasibility><animation><assess effectiveness><behavioral assessment><behavioral health><burn-out><burnout><cohort><community intervention><community level intervention><community planning><community-based intervention><cost effectiveness><design><designing><determine effectiveness><drug treatment><drug/agent><effectiveness and implementation trial><effectiveness assessment><effectiveness evaluation><effectiveness outcome><effectiveness-related outcomes><effectiveness/implementation hybrid study><effectiveness/implementation hybrid trial><effectiveness/implementation study><effectiveness/implementation trial><evaluate effectiveness><evaluate implementation><evaluation of implementation><evidence base><examine effectiveness><hands><health care personnel><health care worker><health provider><health workforce><healthcare personnel><implementation evaluation><implementation intervention><implementation outcomes><implementation process><implementation/effectiveness><incarcerated><incarceration><intervention for prevention><interventional strategy><medical personnel><medical specialties><medication for opioid use disorder><meeting><meetings><member><mortality><needle exchange><novel><outreach><overdose death><overdose fatalities><peer recovery><people who use drugs><people who use illicit drugs><persons who use drugs><prevent><preventing><prevention intervention><prevention service><preventional intervention strategy><preventive intervention><programs><recovery services><recovery support services><referral services><rural locality><rural place><rural setting><scale up><skills><social role><substance use><substance use and disorder><substance using><syringe exchange><syringe exchange services><syringe service programs><tool><transmission process><treatment provider><treatment services><trial design><viral transmission><virus transmission>