RecruitingNCT05404750

Harm Reduction in HIV Primary Care for PLWH Who Use Drugs

Impact of Harm Reduction Care in HIV Clinical Settings on Stigma and Health Outcomes

Sponsor

University of Pittsburgh

Enrollment

768 participants

Start Date

Apr 20, 2022

Study Type

OBSERVATIONAL

Conditions

Substance Use Human Immunodeficiency Virus Stigma, Social

Summary

People living with HIV (PLWH) who use drugs experience significant health disparities including lower rates of retention in HIV care and higher rates of unsuppressed viral load, resulting in secondary infections and increased mortality. The proposed study will used mixed methods to explore (a) the relationship between healthcare providers' attitudes towards working with PLWH who use drugs and providers' acceptance and practice of structural and relational harm reduction; (b) the degree to which relational harm reduction moderates the effect of intersectional stigma experienced in healthcare settings on patients' perceptions of their relationship with providers; (c) the degree to which structural HR moderates the relationship between the patient-provider relationship and clinical outcomes, and (d) whether patient-perceived HR approaches to care are directly associated with HIV clinical outcomes. The study will also use these findings to inform the development and pre-testing of an intervention to operationalize harm reduction in HIV clinical settings, using stakeholder-engaged and human-centered design approaches, presenting a novel path to reducing HIV health inequities for PLWH who use drugs.

Eligibility

Min Age: 18 Years

Inclusion Criteria9

Working at one of our 3 study sites (UPMC HIV/AIDS Program, Positive Health Clinic, or 1917 Clinic) or one of their partner sites offering substance use treatment (Internal Medicine Recovery Engagement Program, Center for Inclusion Health, or UAB's Outpatient-Based Opioid Treatment Clinic) for at least one year
Providing service or care to PLWH or people who use drugs at high risk for HIV acquisition
Working in one of the following positions: front desk/patient engagement, social worker, nurse, medical assistant, advanced practice provider, or physician
Able to verbally consent, read, and speak English
Living with HIV
Age 18 or older
Able to verbally consent, read, and speak English
Receiving HIV medical care from one of the study sites for at least one year
Lifetime or recent use (past 3 months) of illicit substances (excluding marijuana) or prescription drugs for non-medical reasons in accordance with the NIDA-Modified ASSIST 2.0.

Exclusion Criteria1

Interventions

BEHAVIORALHarm Reduction

Harm reduction aims to reduce negative effects of risky health behaviors without necessarily terminating the behaviors completely.Though often thought of as structural approaches (e.g., policy or syringe services), Harm reduction is also a relational approach to care focusing on non-punitive patient-provider interactions to promote autonomy. The degree to which harm reduction care is offered in study settings and is associated with clinical outcomes is the focus of this study.