ABSTRACT Co-occurring substance use and HIV risk among people in carceral settings is a syndemic. Approximately 17% of all incarcerated people have an opioid use disorder (OUD), and the prevalence of HIV is 3-5 times that of the general population. Gold standard interventions exist to stem adverse OUD outcomes and prevent HIV infection: pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD, e.g., buprenorphine). However, implementation of these efficacious interventions is underemployed in carceral settings and during community re-entry, and even when they are put into practice, barriers to optimal uptake, adherence, and continuation often occur. However, long-acting injectable (LAI) formulations of both PrEP and buprenorphine have recently been approved by the FDA, providing opportunities to innovate on how these medications are deployed. In addition, evidence in the community proves that MOUD + HIV efforts, when delivered in tandem, improve outcomes for those with OUD, and that retention in MOUD predicts positive HIV prevention outcomes. Therefore, we propose conducting a hybrid implementation-effectiveness type 2 study to optimize and test the efficacy of a LAI PrEP + buprenorphine (XR-B) co-packaged intervention among people in carceral and community re-entry settings in Ending the Epidemic Sites in Maryland and Washington, DC. Our specific aims are: Aim 1 (R61): Develop the intervention protocol for delivery of LAI PrEP + XR-B; Aim 2 (R33): Evaluate implementation facilitation as a strategy to support co-located LAI PrEP + XR-B in carceral and re-entry settings; and Aim 3 (R33): Compare the effectiveness of LAI PrEP + XR-B to oral PrEP +SL-B. Our long-term goal is to 1) provide guidance on how to implement LAI interventions in these settings, 2) generate evidence relevant to the efficacy of co-packaging LAI PrEP + XR-B to improve adherence and continuation of PrEP and buprenorphine.

NARRATIVE Co-occurring substance use and HIV risk among people in carceral settings is a syndemic. Yet, gold standard interventions to stem adverse OUD outcomes and prevent HIV infection (e.g., pre-exposure prophylaxis, PrEP; and medications for opioid use disorder, MOUD, e.g., buprenorphine) have been underemployed in carceral and community re-entry settings. Therefore, we propose conducting a hybrid implementation-effectiveness type 2 study to optimize and test the efficacy of a long-acting injectable PrEP + buprenorphine (XR-B) co-located intervention in jail and prison settings located in Ending the Epidemic Sites in Maryland and Washington, DC.