Prison Release Engagement Trial (PRET): Randomised trial of App-coordinated daily bot contact to improve prison-release continuity of care: testing engagement with OST medication-assisted treatment or medication-free support.

Research Question: Can current low levels of continuity of care post-release from prison be improved by harnessing the power of Contingency Management (CM) delivered via interactive smartphone app?

To address this need, we will refine and test an interactive smartphone app to improve continuity of care post-release for prisoners wanting to stay drug-free by bringing the power of CM into the pocket of the individual.

Background: Prisons in England have a throughput of 150,000 individuals released annually, of whom a quarter have heroin use histories. While in prison, many individuals receive either pharmacological or mutual-support addiction treatment.

However benefit gained is frequently lost within days when they encounter problems on transitioning to community: only 41% of releasees successfully engage with their personalised treatment/support in the first 21 days post-release.

The Government Drug Strategy identifies continuity of care (CoC) as a key priority and sets a target of 75% engagement with treatment post-release. Initiatives to improve post-release CoC have made slow progress thus far.

Aims: Contingency Management (CM) is identified by NICE as an evidence-based treatment which reinforces specified positive behaviours such as treatment engagement and can enhance both medication and non-medication interventions. We bring CM, delivered by innovative app technology, into the hands of individuals in need.

We will co-develop/refine the app and interactive elements, conduct randomised trial of post-release continuity of care, and, if effectiveness and cost-effectiveness demonstrated, will disseminate and guide wider application and future commercialisation.

Method and Timeline: Year 1: Consult former prisoners about needs and preferences; work with app-developers on adaptation and technical aspects.

The interactive app will prompt first appointment, make daily contact, enable links for support, with CM voucher schedule of incremental incentives for responding to daily check-in notifications over 21-day post-release period.

Year 2: Randomised trial of the app (versus care-as-usual) in six prisons across England, working with new prison-based and in-reach workforce to recruit 988 released prisoners (men and women) with history of heroin use and wishing to remain drug-free post-release. We will study elements of app-engagement and also measure extent of improvement in post-release continuity of care.

The study is powered to detect improvement from 41% to 51%.

All participants receive at least current aftercare: 658 participants randomly assigned to additionally receive the app, the remainder (330) receiving usual care. All 988 participants will receive a smartphone with pre-paid SIM-card (three months) to enable follow-up.

Year 3: Conclude randomised trial, analyse the app-generated and validation data, and report back to service users and commissioners/policymakers to guide further adaptation of the app for wider availability and commercialisation. Widely-available dissemination event.

PPIE: we have active support from PPIE communities (including co-applicant) and have identified ongoing working groups to guide app development and the trial process, and will carry through to dissemination and generation of impact.

Impact and Dissemination: Through digital technological innovation, improved continuity of care will be achieved for individuals leaving prison with history of heroin use. Our research findings will be shared through PPIE and stakeholder feedback groups alongside conference presentations.