Trauma-informed, resilience-based telehealth intervention for improving HIV prevention and HCV care for persons who inject drugs in the Deep South

PROJECT SUMMARY/ABSTRACT Persons who inject drugs (PWID) are at elevated risk for HIV and Hepatitis C Virus (HCV) due to needle sharing and unsafe sexual practices. Amidst the unprecedented opioid epidemic, injection drug use (IDU) has increased in the rural areas of the Deep South. Recent outbreaks of HIV and the ongoing HCV epidemic

among PWID living in the rural USA underscore the importance of promoting HIV Pre-Exposure Prophylaxis (PrEP) and HCV care, and medications for opioid use disorder (MOUD) for PWID. Traumatic experiences, like Adverse Childhood Experiences (ACEs), may lead to IDU, unsafe sexual practices, lower HIV testing, lower

PrEP use, higher perceived stigma, and lower resilience in later life. Tailored behavioral intervention for PWID is urgently needed, particularly given the health disparities experienced by PWID living in the rural Deep South. One innovative approach is to reach PWID via telehealth interventions for promoting PrEP, HCV care, and

MOUD. Thus, the scientific objective of this K01 is to assess barriers and facilitators that PWID, living in the rural areas of Georgia and South Carolina, face in obtaining PrEP, HCV care and MOUD, and then use these findings to inform the development of a theory-driven, trauma-informed, and resilience-based telehealth

intervention designed to increase willingness to uptake care. The career development objective of this K01 is to obtain the comprehensive mentored training necessary to develop expertise in improving HIV prevention, HCV care and MOUD for PWID in the Deep South through telehealth interventions. It is supported by the

highly productive research environment at the University of Georgia and a team of accomplished researchers in HIV and HCV prevention and care, MOUD, trauma-informed care, resilience-based stigma reduction, and telehealth intervention development and implementation. This mentored training experience will provide

expertise in behavioral intervention development; adaptation of existing evidence-based interventions; telehealth intervention development and implementation; theater testing methods; randomized trial designs; analytic techniques for assessing intervention feasibility, fidelity, acceptability, usability, and efficacy. Training

outcomes are linked to three specific aims. In Aim 1, I will assess the perceptions of PWID and healthcare providers and policymakers to identify barriers to and facilitators of PrEP, HCV care and MOUD uptake in the context of intersecting stigma. Using these findings in Aim 2, I will develop a theory-driven, multi-component

telehealth intervention to improve HIV prevention, HCV care and MOUD uptake among PWID with 6 bi-weekly sessions. In Aim 3, I will evaluate the feasibility, acceptability, and usability of the telehealth intervention with a randomized pilot trial with 50 PWID living in the rural Deep South. This project is responsive to the NIDA

priorities of trauma research, prevention services, and social determinants of health to optimize HIV prevention and HCV care continua among PWID in the Deep South.