Addressing the syndemic of SUD, IPV, and HIV through trauma-informed, peer-delivered screening, brief intervention and linkage from EDs to HIV clinic and community-located holistic care

About This Grant

ABSTRACT People with HIV (PWH) with substance use disorders (SUDs) are at high risk of worse HIV-related health outcomes. Further, SU forms a complex syndemic with intimate partner violence (IPV), wherein SUD and IPV commonly co-occur and additively, negatively impact HIV care engagement by increasing risk of mental health disorders, housing, financial, and food insecurity, and weakening social support and executive function. Thus, integrated screening, treatment, and support for IPV and SU alongside HIV care linkage/re-linkage and retention efforts is critical. Emergency departments (EDs) are ideal venues for linking newly-diagnosed PWH, re-linking PWH who have been out-of-care, and initiating comprehensive, needs-driven support for PWH to be retained in HIV care long-term. Unfortunately, sustained retention in HIV care after initial linkage/re-linkage to HIV care from EDs is poor and particularly challenging for PWH with SUDs and mental health disorders. We hypothesize that the low rates of retention after initial linkage/re-linkage of PWH from the EDs is due to missed early opportunities in addressing barriers to retention like SUDs, IPV, and comorbid mental health disorders, housing insecurity, and fractured social support. Building on the evidence-base demonstrating the impact of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and peer-driven processes in EDs to link patients to subsequent services for SUDs and existing support services in Ryan White HIV Clinics (RWCs) and community, we propose to develop and pilot comprehensive implementation strategies to support delivery of an ED-based “Peer Bridge Model (PBM)” targeting PWH that utilizes multiple evidence-based practices: (1) peer linkage specialists (due to their capacity to understand and build trust with patients, fewer time constraints, and cost-efficiency) to (2) screen for IPV, SUD, and co-occurring mental health and support needs, (3) deliver Psychological First Aid (PFA), a brief, trauma-informed intervention widely employed to help individuals in the aftermath of experiencing a trauma, with (4) warm linkage to comprehensive, existing services (i.e., mental health, substance use, and peer counseling, case management, and housing assistance) in local community-based organizations and RWCs. Specifically, we aim to: 1) Identify and develop patient-centered and contextually responsive implementation strategies to facilitate delivery of the PBM using a Modified Delphi process with multiple stakeholders, 2) Refine the implementation strategies developed in Aim 1 to a specific delivery context through theater testing with PBM implementing stakeholders; and 3) Pilot and perform a mixed-methods evaluation of the preliminary effectiveness of the implementation strategies on PBM implementation outcomes at a high-volume ED in Atlanta capturing multistakeholder perspectives at 0, 3 and 6 months post implementation onset to examine acceptability, feasibility, fidelity, reach, patient satisfaction, adaptations, and barriers/facilitators to intervention implementation and efficacy. Findings will inform a future Hybrid Type 2 effectiveness-implementation trial examining the impact of the PBM in enhancing linkage and retention on HIV care, SUD and IPV outcomes.