Mobile care for persons with opioid use disorder aims to improve HIV prevention and treatment, and reduce opioid overdoses and deaths

A pilot study that hits the road to address two intersecting epidemics-– HIV among people who inject drugs and opioid dependence-– is underway at The University of Texas Health Science Center at Houston (UTHealth). 

The research team hopes to better understand if providing integrated mobile health care services will help improve the uptake of medication-assisted recovery (MAR) for opioid use disorder, thereby preventing overdoses and deaths, and antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) in individuals who inject opioids, compared to referrals to pre-existing, singular, brick and mortar services.

“In Harris County, there are both large numbers of new HIV acquisitions each year, and high rates of deaths and overdoses linked to opioid use,” said Jordan E. Lake, MD, MSc, an associate professor of infectious diseases at McGovern Medical School at UTHealth and the study’s local principal investigator. “Through the work of a multidisciplinary team, we hope to reduce opioid-related overdoses and deaths and acquisition/transmission of HIV in people who inject drugs by providing them with ‘one-stop’ care for treatment, prevention, and recovery.”

In 2017, over 70,000 people died from drug overdoses in the United States, and 68% of those deaths were linked to opioid use. People who inject drugs risk both overdose and HIV transmission and acquisition, but often face multiple barriers to care, such as access to treatment and medications for opioid use disorder.

Participants in the intervention group will receive mobile, integrated health care as well as peer navigation from medical and recovery experts for 26 weeks. These services include medication and harm reduction services for opioid use disorder; testing for HIV, viral hepatitis, and other sexually-acquired infections (STI); medications for HIV/STI treatment and prevention; and testing and referrals for other health care needs, including routine vaccinations, viral hepatitis treatment, and other primary care and  harm reduction services.

The Houston Emergency Response Opioid Engagement System, or HEROES, will direct the peer navigation portion of the intervention. A joint initiative, led by experts at McGovern Medical School and the School of Biomedical Informatics at UTHealth, the HEROES program includes MAR to treat opioid dependence, as well as peer support and counseling from a recovery coach.

“Through this study, we will be able to meet people with opioid use disorder where they are, with health services that are judgment-free and supported by peer navigation,” said James Langabeer, PhD, EdD, MBA, a coinvestigator on the study and a professor of biomedical informatics, emergency medicine, and public health at UTHealth.

Following the first 26 weeks of the trial intervention, participants will be transitioned to other community-based services to address their health care needs.  

Eligible participants include adults ages 18 to 60 with opioid use disorder who inject drugs, are at risk of acquiring HIV or are living with HIV, and willing to start opioid use disorder treatment.

Other UTHealth study team members include Roberto Arduino, MD; Karen Vigil, MD; Qiana Allen, NP; Tom Fadial, MD; Shabana Walia, MD, MPH; Maria Martinez, PhD; Jonatan Gioia, MD; Olga Popova, PhD; and Olatunde Oladipupo. The peer coaching team, led by Jessica Yeager, includes Kristina Davis and Stephanie Burns. Study coordinators include Ruda Mohaweche, MD, and Zakir Hossain, MD. Joseph Sanchez will drive the mobile unit and manage security operations.