Implementation of comprehensive telehealth models to address the HIV and substance use disorder syndemic among people who inject drugs - The HIV and substance use disorder (SUD) syndemic has complicated progress toward the Ending the HIV Epidemic (EHE) initiative’s goals of reducing new HIV infections in the United States (US) by 75% by 2025 and 90% by 2030. People who inject drugs (PWID) accounted for 11% of new HIV infections in the US in 2021. However, PWID experience challenges when accessing the traditional healthcare system, leading to almost universally poorer health outcomes compared to non-PWID. Thus, evidence-based interventions, such as telehealth, are needed to improve access to and sustained implementation of HIV and SUD care in places PWID frequent and feel comfortable, such as organizations dedicated to serving their needs. The acceptability, appropriateness, and feasibility of telehealth for HIV and SUD care have been demonstrated in pilot studies, and its effectiveness is currently being studied in two randomized controlled trials by my sponsors. However, only 30% of organizations serving PWID in the US report offering telehealth services, and the scalability of telehealth as a healthcare model based in such organizations has yet to be assessed. This proposed study, guided by the Implementation Research Logic Model (IRLM), will explore patterns of existing healthcare services at organizations serving PWID in the US and identify implementation determinants, strategies, and mechanisms influencing the scalability of telehealth nationwide. Aim 1 will define existing patterns of healthcare service delivery using latent class analysis of data from the National Survey of Syringe Services Programs and examine organizational correlates of class membership. Aim 2 will confirm the construct validity of new measures for three implementation outcomes—Acceptability, Appropriateness, and Feasibility—in this organizational context using confirmatory factor analysis, then determine whether they serve as proximal implementation outcomes that influence telehealth adoption using SEM. Aim 3 will use rapid qualitative analysis guided by the Consolidated Framework for Implementation Research to identify implementation facilitators for telehealth in these organizational contexts, then select corresponding implementation strategies from the Expert Recommendations for Implementing Change (ERIC) compilation, culminating in a IRLM that can be used to guide scale-up of telehealth at organizations serving PWID nationwide. These aims are embedded within a training plan designed to build my competence in advanced quantitative and qualitative methods and prevention and implementation science, while facilitating my success as a physician-scientist specializing in HIV and SUD. Additionally, this proposal addresses two priority scientific areas in NIDA’s 2022-2026 Strategic Plan: research at the intersection of HIV and substance use and on the implementation of evidence-based interventions in real-world settings, and it advances progress on multiple priorities within the Agenda for Implementation Outcomes Research: 2022–2032.
