Project Summary/Abstract This supplement aims to explore the impact of the infusion of health equity principles on overdose prevention strategies during the implementation of the Communities That Heal (CTH) intervention as part of the HEALing Communities Study (HCS). The HCS is a multi-site, parallel arm, cluster randomized, wait-list controlled trial evaluating the impacts of the CTH intervention, compared with usual care in wait-list communities, on overdose deaths. The overall goal of the HCS is to reduce opioid overdose deaths by 40% in 67 HCS communities across four states. Communities form coalitions to make shared decisions about what overdose prevention strategies to implement and how best to implement them, particularly strategies that promote Overdose Prevention Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). Even though minoritized communities (whether due to race, ethnicity, gender, or LGBTQIA+ status) have less and poorer access to treatment for Opioid Use Disorder (OUD) and associated disparities in outcomes at its outset, HCS did not explicitly aim to reduce disparities or measure the effect of centering equity on overdose prevention. This approach changed in 2020 with an acute awareness of the racial and ethnic disparities within the COVID epidemic and the racial awakening in response to the George Floyd killing. This supplement will leverage its parent study existing staff and infrastructure and study staff to analyze surveys and other qualitative data already collected. The primary data sources will include surveys of coalition members, completed at four-time points during the study period; the Opioid-Overdose Reduction Continuum of Care Approach Tracker (ORCCAT), completed monthly by study staff, that includes overdose prevention information by strategy, sector, venue, population served, coalition approval date, implementation plan developed, date started, number of partners/practices associated with strategy, and mode of delivery; and REACH data, completed by study staff monthly once each strategy is implemented that includes information on number of persons reached and demographics of those reached (e.g., race, ethnicity, sex, age). Data analysis will consist of qualitative analysis looking at associations between survey answers regarding health equity topics and incorporation of equity into strategies, and qualitative analysis examining how coalitions discussed and prioritized equity topics. The parent study’s PRISM/RE-AIM(S) conceptual framework will guide this study with a novel health equity lens to examine how diversifying coalitions and infusing opioid overdose prevention strategies with health equity principles may help reach minoritized communities and how these contextual factors and processes may interact to promote or impede health equity. Results from this study may be used to inform policies, strategies, and practices for incorporating health equity principles when implementing overdose prevention strategies.

PROJECT NARRATIVE This supplement aims to explore the impact of the infusion of health equity principles on overdose prevention strategies during the implementation of the Communities That Heal (CTH) intervention as part of the HEALing Communities Study (HCS). We will analyze existing survey data of community coalition members, process data describing successfully implemented overdose prevention strategies, and coalition meeting minutes that provide essential context for decision-making around health equity principles. This study will be guided by the parent study’s PRISM/RE-AIM(S) conceptual framework with a novel health equity lens to examine what contextual factors and processes promoted or impeded the incorporation of health equity principles into overdose prevention strategy implementation.