PROJECT SUMMARY
Opioid use continues to be a public health crisis in the United States (US). An estimated 2.7 million people
had opioid use disorder (OUD) with over 107,000 overdose deaths in 2022 in the US. OUD is also a major risk
factor for HIV infection due to injection and high-risk sexual behaviors. Despite the higher risk of HIV, OUD
patients have had very limited engagement with HIV prevention services, including HIV screening, HIV pre-
exposure prophylaxis (PrEP), and medication for OUD (MOUD) services, which are highly effective in
preventing HIV infection. Novel approaches are needed to explore how to engage people with OUD in HIV
prevention services with the long-term goal of reducing HIV incidence. The integration of HIV prevention
services into care setting (e.g. emergency departments, primary care, mental health clinics, and substance
treatment centers) where people with OUD already seek care is promising. As the integration of HIV prevention
services into care settings is complicated due to the individual-, social- and structural-level barriers, we will use
innovation and multidisciplinary approaches to achieve this goal. In this proposal, we will conduct a systematic
assessment of healthcare utilization in general, HIV prevention services, and MOUD using the All Payers
Claims Database (APCD) and State Emergency Department Database (SEDD) (specific aim (SA) 1), use the
Evidence-Based Quality Improvement (EBQI) - a collaborative stakeholder-guided intervention/strategy
development process to determine the optimal care setting and identify implementation strategies of integrating
HIV prevention services and MOUD (SA 2), and then test their effects on reducing HIV incidence at the
population level using agent-based modeling (SA3). This innovative study will identify care settings to
maximum HIV prevention efforts, test multiple promising implementation strategies, and identify the most
effective implementation strategy, which is ready for real-world implementation.
