Evaluating the use of long-acting antiretroviral treatment for HIV during community re-entry: Addressing community and structural barriers

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Abstract Persons who experience incarceration are disproportionately impacted by HIV infection. The time of release from carceral settings, known as community re-entry, is a period of particularly high risk for persons with HIV. During this time, people are at an increased risk of viral rebound due to poor ART adherence, substance use relapse, inability to engage with community HIV providers, inability to fill ART prescriptions, and competing needs in the chaotic environment to which individuals return. Long-acting injectable (LAI) ART is a new alternative to help overcome the challenges of adhering to a daily regimen of oral medication. However, little is known about how best to develop and optimize LAI ART interventions in this population. Therefore, we propose exploratory implementation research that will provide additional preliminary data to enhance our understanding of LAI ART implementation in diverse Ending the HIV Epidemic (EHE) areas in the mid-Atlantic region: Prince Georges County, MD; and Washington, DC. Using the Consolidated Framework for Implementation Research—a theoretical model that guides investigation into the factors that influence implementation, we propose interviewing stakeholders in each of the above EHE areas and conducting a Delphi study. Specific focus will be placed on linkage to a broad array of health services (e.g., mental health, substance use, the need for peer or community health worker services) and the structural barriers that might be present in each location (health insurance, housing, employment, poverty). Our specific aims are to: 1) identify how to optimize future LAI ART interventions in community re-entry populations by interviewing 15 stakeholders at each site (total n=45), and 2) co-produce best practice guidelines for future LAI ART interventions by conducting a Delphi study with 30 experts. The proposed project maps onto the objectives of the funding announcement in that we will conduct implementation research to develop a LAI intervention that addresses multi-level factors that are key to facilitating linkage to innovative HIV treatment modalities. Findings from the supplement supported research will be the foundation of a future R01 application and, importantly, will be shared back with our EHE implementation, governmental, and community partners at each EHE site.