Project Abstract Improving HIV and Opioid Use Disorder (OUD) management and implementation for criminal justice (CJ)- involved individuals requires effective approaches to screening, linkage and adherence to integrated services across community agencies and service providers. Community reentry represents a critical opportunity to link individuals to HIV prevention and treatment and OUD service providers. In response to RFA DA-20-028, our proposed study called Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations, is a 5-year Hybrid Type 1 Effectiveness- Implementation RCT that compares two models [Patient Navigation (PN) or Mobile Health Unit (MHU) service delivery] of linking individuals recently released from prison and jail to the continuum of community-based HIV and OUD prevention and treatment service cascades of care. A total of 864 CJ-involved individuals who are being released to 2 CT communities (New London and Windham/Tolland Counties) & 2 TX communities (Dallas and Tarrant Counties) with pre-arrest histories of opioid/injection drug use and are living with or at-risk of HIV will be randomized to receive at post-release either: a) a PN system for care, wherein patient navigators will link study participants to community-based service providers during the 6-month post-release intervention period; those without HIV will be provided access to PrEP services, and those living with HIV will receive access to ART services, or b) services delivered via a MHU, wherein study participants will be linked to a MHU within their community where they will receive integrated PrEP/ART, MOUD, harm reduction services on the MHU during the 6 month post-release intervention period. There are 2 specific aims: Aim 1 (Intervention Effectiveness): To compare the effectiveness of the use of PN vs. MHU service delivery on participant length of time to taking initial post-release PrEP (prevention)/ART (treatment) medication within 6 months following release from custody. Secondary outcomes will examine the continuum of PrEP and HIV care outcomes, including (but not limited to) the following additional measures: HIV viral suppression for PLH, PrEP adherence, HIV risk behaviors; HCV measures such as HCV testing & linkage to treatment; sexually transmitted infection (STI) incidence (GC/ Chlamydia/ Syphilis and HBV); and primary medical care appointments. Importantly, we will also assess OUD and SUD-related measures: OUD/ SUD diagnoses, MOUD prescription receipt &retention, opioid & stimulant use, & overdose incidents. Aim 2 (Implementation): To evaluate PN and MHU feasibility, acceptability, and costs. Primary implementation outcomes include feasibility (health care utilization impact among released individuals, contributions of interagency workgroup members on outcomes); acceptability (participant satisfaction, perceived usefulness); sustainment (continued utilization), and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Barriers to service access across the community provider spectrum will be assessed as well.

Project Narrative Our proposed study called Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations, focuses on the need to improve linkage to HIV prevention and treatment and Opioid Use Disorder services for criminal justice-involved individuals by comparing the effectiveness and implementation of Patient Navigation (PN) and Mobile Health Unit (MHU) intervention models for service delivery in four highly at-risk geographic territories in Connecticut and Texas. Providing the evidence base to support effective implementation approaches that improve linkage to and engagement in integrated community services is critical to preventing new HIV infections among persons who inject drugs and those with opioid use disorders who are being released from prison and jail to the community.