"Delivering high-quality care in this setting requires a lot of resources": HPTN 094 Implementation Lessons from Delivering Integrated HIV and MOUD Care Through Mobile Units In Local Neighborhoods.
Tsuyuki, Kiyomi; El-Krab, Renee; Shoptaw, Steven; El-Bassel, Nabila; Lake, Jordan E; Magnus, Manya; Kuo, Irene; Goodman-Meza, David; Denis, Cecile; Nieto, Omar; Franks, Julie; Villareal, Yolanda R; Smith, Peter; Bornstein, Sydney; Andrew, Philip; Harris-Wisecarver, Jayla; Choudhury, Rahul Paul; Perez-Brumer, Amaya; Davidson, Peter; Smith, Laramie R; HPTN 094 study team
Abstract
BACKGROUND: The HIV Prevention Trials Network 094 INTEGRA study sought to fill the gap in implementation science literature by exploring the delivery of integrated prevention and care for HIV and opioid use dependence (OUD) through mobile units to people who inject drugs (PWID). SETTING: Five U.S. INTEGRA sites with diverse implementation landscapes disproportionately affected by the HIV and opioid epidemics (New York, Philadelphia, Washington, DC, Houston, Los Angeles) . METHODS: In-depth qualitative interviews from an embedded implementation science evaluation were conducted with 37 clinical and research INTEGRA staff delivering integrated care through mobile units. Pragmatic qualitative analysis was guided by the PRISM framework to identify key implementation needs, challenges, and solutions for delivering the INTEGRA intervention via mobile units in local neighborhoods. RESULTS: Staff described how mobile delivery of INTEGRA reduced key barriers that limit PWID access to HIV and OUD services. Yet, they also detailed complex implementation needs, including the proactive coordination among staff to ensure sustained access to INTEGRA services, navigating internal and external spaces to deliver services, maintenance-related demands to keep the mobile unit's infrastructure operational, and interdependent efforts that bridged the mobile unit's service delivery within the extant health systems and community landscapes. CONCLUSION: Findings demonstrated that mobile integrated care models can reduce access barriers for PWID but require tailored implementation strategies to address operational, spatial, infrastructural, and community-level demands. Results may help inform an implementation blueprint for similar communities working to respond to the intersecting HIV and opioid epidemics affecting PWID across U.S. settings.