Testing the Effectiveness of a Remote Intervention to Reduce Infection Risk in Rural Areas of the United States - PROJECT SUMMARY Partly due to inaccurate beliefs about substance use disorder and inadequate public policies, the substance use epidemic has increased associated risks of infection with the Human Immunodeficiency Virus (HIV) and viral hepatitis (e.g., Hepatitis C Virus [HCV]) in rural regions of the United States. Identifying efficacious programs that are effective and scalable remains imperative. The proposed project, submitted in response to RFA-DA-25024, High Priority HIV and Substance Use Research, will examine the effectiveness of a virtual social intervention to increase HIV/HCV testing and prevention in rural areas of the US. The intervention convenes people with recent substance use and members of the community at large via Zoom to increase social integration, decrease negative beliefs, and improve pro-health norms in all involved. In addition to increasing social capital, the intervention provides remote access to testing and Naloxone (Narcan) and adapts to participants’ needs by promoting individual goal achievement within a group format and through an ad-hoc social platform. The research plan is supported by meticulously collected preliminary data establishing a large effect of the intervention on HIV testing, HCV testing, HIV prevention, and social integration as a composite primary outcome. The approach is also supported by impressive AI (Artificial Intelligence) data on the feasibility of developing an AI Co-Pilot to scale up this intervention by training and providing realtime assistance to community facilitators at a low cost. This five-year project will begin by preparing the infrastructure to conduct an implementation Cluster-Randomized Controlled Trial (C-RCT), including convening our Community Advisory Board (CAB) to cover at-risk rural counties and fine-tuning the AI Co-Pilot (Aim 1). We will enroll 700 participants from high-risk rural locations in the US, half using substances and the other half from the community at large, randomizing them to the AI-assisted intervention or a virtual supportgroup attention control, both with booster sessions (Aim 2). Over the next 6 months, we will measure the outcome of the intervention on a composite index of HIV and HCV testing, HIV prevention, and social integration, as well as each of those outcomes and mental health, substance use treatment seeking, substance use behaviors, and idiosyncratic goal achievement as supplementary outcomes. We will assess theoretical processes that mediate the intervention effects based on measures of norms, social support, goal session and implementation, and testing- and Narcan-kit requests. The project, which will document implementation outcomes, will be conducted by an interdisciplinary team with expertise in psychology, medicine, communication, public health, implementation science, computer science, and biostatistics, from the University of Pennsylvania and the University of North Carolina.
