Implementation of telemedicine and social network driven HIV service uptake for comprehensive HIV service integration in rural syringe service programs

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7. PROJECT SUMMARY / ABSTRACT People who inject drugs (PWID) face multilevel barriers to accessing HIV-related services, including low demand for services, resulting from stigma, low knowledge/awareness of services, and prioritization of immediate basic needs (e.g., food, housing, addiction) over remote health concerns. In rural areas, these barriers are exacerbated by service scarcity. Syringe service programs (SSPs), a cornerstone of HIV prevention among PWID, are trusted by this population and have the potential to extend the reach of other evidence-based services (pre-exposure prophylaxis [PrEP], medication for opioid use disorder [MOUD], HIV treatment, etc.). Telemedicine provides a sustainable method to deliver services where they are scarce. We successfully piloted telehealth delivery of HCV treatment and MOUD for PWID at rural SSPs. We will adapt and expand on our telemedicine pilot to bring HIV prevention and treatment services to rural SSPs. However, service availability does not equate to uptake. Social network-based interventions have proven effective in disseminating health information and HIV risk reduction among PWID. Peer-based interventions have an unparalleled potential to overcome stigma and trust barriers in marginalized groups, reach “hidden” group members (i.e., those who do not access services at the SSP), and empower individuals to make positive changes. Low rates of HIV testing and diagnosis among PWID remain a barrier to linkage to antiretroviral therapy initiation (for HIV infected) and PrEP (for HIV-uninfected). A key innovation of our intervention will be to combine dissemination of information with distribution of HIV self-testing kits through PWID networks. HIV self-testing strategies are endorsed by the World Health Organization and have been shown to increase testing coverage and new HIV diagnoses in high prevalence regions of sub-Saharan Africa and among MSM, but have been little explored among PWID. We propose to evaluate a model that leverages peer educators to disseminate HIV self-testing kits and information while also providing peer navigation to network members for HIV prevention and treatment services uptake via telemedicine at rural SSPs We plan a hybrid effectiveness/implementation approach. Aim 1a: We will use a community-engaged approach to adapt a preexisting PWID-focused network intervention to a rural context with the goal of increasing HIV self-testing and HIV service uptake. Aim 1b: We will determine the effectiveness of the intervention compared with an equal-attention control condition, using a rigorous randomized trial design. Aim 2a: In contemplation of adoption and sustainability, we will use mixed methods to characterize implementation processes and outcomes. Aim 2b: to explore intervention mechanisms, we will establish the extent to which SSP and HIV service uptake are related to experiences of social influence and stigma.