TechMPower: Advancing HIV/SUD Care and Service Delivery for People Involved in the Criminal Legal System

Project Summary HIV prevalence in correctional facilities in the US is about five times greater than in the general population and about 14% of people living with HIV (PLWH) experience incarceration/release every year and 15% of those incarcerated do not know their HIV status. Over 50,000 people are incarcerated in New York state and 1-2% are estimated to be PLWH. Similarly, substance use disorder (SUD) is highly prevalent among criminal-legal system (CLS)-involved people, with an estimated 70-80% of US jail detainees having a SUD are at high risk of relapse, overdose- related mortality and HIV infection post-release. Intervening during incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though more robust interventions are needed to improve care continuity. Increasing point-of-care rapid testing would maximize HIV detection and results receipt among people in jails, and prepare them with needed knowledge and skills post-release. To fill this gap, we propose a Regional Research Hub (RRH) and 2-phase, Hybrid Type II effectiveness/implementation study to evaluate the effectiveness of TechMPower, an intervention that bundles implementation strategies to increase delivery of evidence-based intervention (EBPs) to prevent adverse HIV-related (new infection, untreated HIV) and SUD-related outcomes (fatal and non-fatal overdose) among a sample of individuals (n=1125 ) in 15 New York State county jails. In the first phase, we will pilot TechMPower to prepare for the phase two full R33 trial, informed by PRISM/RE-AIM and the health equity framework, by recruiting in one NYS county jail (n=50) and an existing HEALing Communities Study coalition to implement the selected EBPs to increase: 1) HIV screening/testing via self-testing (TRUST); 2) SUD screening/testing (SBIRT); and 3) access to and uptake of biomedical HIV and SUD prevention and treatment (PrEP/PEP/ART); overdose education/naloxone distribution [OEND], opioid use disorder medication [MOUD]) delivered through 4) hybrid linkage (telehealth, face-to-face) to services via Navigation Enhanced Case Management (NCM). To optimize EBP delivery, TechMPower applies key implementation strategies including: a) data driven, equity-focused, community coalitions; b) implementation teams led by champions; c) training in intersectional stigma/harm reduction for service providers/organizations from CHHANGE; and d) tech-mediated trainings. This study capitalizes on investigators’ experience in community-driven implementation studies, EBP design, and equity/anti-stigma approaches to provide evidence for tech-mediated HIV and SUD service delivery integration in jails with linkages to community-based care.