University of Washington Developmental AIDS Research Center for Mental Health (UW ARCH)

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PROJECT SUMMARY/ABSTRACT People with HIV who are releasing from prison are at elevated risk of dropping out of HIV care, transmission of HIV to others, and mortality, specifically mortality due to drug overdose. Opioid use disorder (OUD) is a preventable risk factor for poor linkage to community-based HIV care, nonadherence to antiretrovirals, HIV transmission, and overdose after release from prison. Medication for OUD (MOUD) decreases HIV risk behaviors, opioid use, and overdose and is now available in many prisons, including Washington state prisons. Determining whether people have OUD is necessary to ensure that the appropriate patients initiate MOUD and link to addiction services upon release. Identification of people with OUD, however, is complex in the prison setting. Few OUD assessment tools are validated in justice-involved populations, and those that exist are not necessarily widely implemented. HIV transmission risk assessment could be integrated into OUD assessment, providing a comprehensive picture of risk and ensuring status-appropriate referrals to HIV care or prevention services upon release. We are aware of no HIV risk assessment tools that are widely used in prisons, though community-based instruments are available. Prisons are complex implementation environments, due to stigma of OUD and HIV, understaffing, and a primary focus on public safety not public health; this necessitates an implementation-focused approach to integration of OUD and HIV risk assessment. The goals of this supplement application are to 1) understand the perspectives of key stakeholders on identification of OUD and HIV risk among people in prison and 2) work with Washington prison stakeholders to select appropriate tools for OUD and HIV risk assessment and select and adapt implementation strategies to integrate these tools into routine practice. We will first conduct a total of 45 interviews with three groups of stakeholders: 1) Washington prison staff, 2) incarcerated people, and 3) recently released people with HIV or HIV risk. We will then observe existing prison health assessment practices to identify barriers and facilitators to identifying OUD and HIV risk. Finally, we will convene a focus group (n=12) that will meet four times to select tools for OUD and HIV risk assessment and adapt implementation strategies. This work will be guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework, and the focus groups will build on principles of Human Centered Design. Our experienced interdisciplinary team, led by Dr. Jack (physician- scientist practicing primary care in Washington prisons) and Dr. Hamilton (addiction health researcher with focus in criminal legal populations) will conduct this multi-staged formative study with support from an HIV expert (Dr. Graham), implementation science expert (Dr. Glass) and behavioral health assessment expert (Dr. Bradley) along with feedback from community partners. This formative work will inform a follow-up study to pilot the implementation strategies and validate an OUD assessment tool in prisons.