The Bellwether Collaborative
for Health Justice
NOTRE
Project Overview
Co-occurring substance use and HIV risk behaviors among people in carceral settings is a syndemic. Approximately 17% of all incarcerated people have an opioid use disorder (OUD), and the prevalence of HIV is 3-5 times that of the general population.
There are gold standard interventions exist that prevent HIV infection and stem adverse OUD outcomes — HIV pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD, e.g., buprenorphine) — yet implementation of these efficacious interventions is underemployed in carceral populations; and, even when they are put into practice, barriers to optimal uptake, adherence, and continuation occur.
Research has found that oral PrEP and sublingual buprenorphine (SL-B) may be difficult to maintain for people leaving incarceration due to competing structural or social needs during re-entry (e.g., housing instability), and difficulties navigating complex healthcare settings. However, long-acting injectable (LAI) formulations of both PrEP (e.g., Apretude) and buprenorphine (XR-B, BRIXADI) have recently been approved by the FDA, providing an opportunity to innovate on how these medications are provided.
Importantly, evidence in the community proves that when MOUD and HIV efforts are deployed in tandem, outcomes for those with OUD improve. Further, that retention in MOUD predicts positive HIV prevention outcomes. Yet, while LAI formulations may overcome many carceral and re-entry challenges implementation approaches that work in other settings may not be ideal for carceral populations.
To that end, the objective of NOTRE is to evaluate and optimize the use of long-acting injectable PrEP and XR-B in carceral populations. Our work will be informed by qualitative research with expert stakeholders involved in carceral and re-entry settings and people who are currently or recently incarcerated to develop our intervention protocols.
Building on this work, we will collaborate with our carceral and community partners in Washington, D.C. and Maryland to concurrently evaluate the implementation of the co-located long-acting injectable PrEP + XR-B intervention (vs. oral versions of both) for individuals leaving incarceration and returning to the community.
MPI Team
Lauren Brinkley-Rubinstein, PhD
Duke
University
Michael Gordan, PhD
Friend's Research
Institute
Curt Beckwith, MD, PhD
The Miriam Hospital
Brown University
Co-Investigators
Mehri McKeller, MD
Duke
University
Thomas Blue, PhD
Friend's Research
Institute
Melissa Zielinski, PhD
The University of
Arkansas Medical School
Research Staff
Hannah Camp, MPH, MSW
Clinical Research Coordinator
Duke University