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.

PROJECT NARRATIVE In light of the ongoing overdose crisis, we will build on prior research evaluating SHIELD, a public-health oriented police education program and structural HIV prevention intervention. We will collaborate with the behavioral health workforce in several rural settings with high burdens of substance use in Appalachian Kentucky to evaluate SHIELD for its implementation and effectiveness outcomes (including increasing referrals to medications for opioid use disorder). This intervention will be a critical step towards broader implementation and scale-up in aligning policing practices with public health to address both HIV and substance use disorder outcomes.