Technology Enhanced Substance Use and HIV Service Navigation for Justice-Involved Young Adults

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Project Summary/Abstract There is a strong scientific premise for the study of integrated substance use disorders (SUDs) and HIV- prevention interventions for criminal justice-involved (CJI) populations. SUDs lead to increased rates of justice involvement as well as increased risk for HIV-acquisition. Estimates of the proportion of the CJI-population with a SUD reach 72%, and ~150,000 persons with HIV pass through a correctional facility annually. Although pre- exposure prophylaxis (PrEP), is a proven effective intervention for HIV-prevention, its maximal impact depends on uptake, and adherence among those at high risk. To date, few published studies have examined PrEP uptake among CJI populations. Our ongoing work with CJI women (San Francisco, CA) has identified high rates of risk behaviors (including substance use), low levels of PrEP awareness, and high levels of interest in PrEP once learning of it. Participants reported a strong interest in participating in a navigator-led intervention to screen and link them to PrEP-related services; younger participants (i.e., those aged 18 to 29 years) were eager to incorporate electronic health (eHealth) into navigation services. Navigator models use a one-on-one relationship to promote the timely movement of an individual through a health care continuum by eliminating barriers and have successfully increased healthcare access for CJI HIV-positive adults and individuals with SUDs. eHealth approaches to SUD and HIV prevention also hold promise because they improve access to effective intervention services, particularly for younger people. As a multidisciplinary team with expertise in behavioral health (substance use and HIV prevention) among justice-involved populations, and eHealth supported and navigator- led healthcare access and engagement interventions, we propose to develop and test an eHealth enhanced, navigator-led substance use and HIV-prevention referral and linkage intervention for CJI-young adults. Study aims are to: 1) Adapt an existing evidence-based navigator model (The Navigation Project) to incorporate codeveloped eHealth technology, to refer and link CJI young adults (aged 18 to 29 years) to substance use treatment and HIV-prevention services; 2) Refine and test the adapted, eHealth enhanced, navigator-led substance use treatment and HIV prevention intervention for CJI-young adults for fidelity, satisfaction, and appropriateness; 3) Assess the feasibility, acceptability, and impact of the adapted eHealth enhanced, navigator program to refer and link CJI-young adults substance use treatment and HIV-prevention services. The proposed study has the potential to: 1) reduce HIV-acquisition and improve access to substance use treatment among a high-risk, underserved group of young adults in the US; 2) test the feasibility, acceptability, fidelity, effectiveness, appropriateness, and satisfaction of implementing an eHealth enhanced, navigator-led substance use and HIV- prevention intervention, and 3) create an intervention suitable for large-scale efficacy testing and translation to other criminal justice settings.