Status: Funded - Open
Lakshmi Ganapathi, MBBS
BACKGROUND: Among the ~850,000 people who inject drugs in India, nearly a quarter are adolescents and young adults. YPWID have a disproportionately high annual HIV incidence (~5%) and experience greater substance use treatment gaps. GAP: YPWID face individual barriers to sustained engagement in treatment programs that provide medications for opioid use disorder (MOUD). This study proposes the development of a mobile phone delivered youth-specific behavioral intervention, “Youth Life-Steps” by peer navigators to address individual barriers and improve MOUD treatment engagement among YPWID at integrated care centers (ICCs) providing HIV services in India. HYPOTHESIS: 1. Younger PWID (i.e., adolescents ≤19 years) have less sustained MOUD treatment engagement compared to older peers. 2. Younger PWID (i.e., adolescents ≤19 years) will need the inclusion of additional supports in Youth Life-Steps, such as defined roles for caregivers to facilitate MOUD treatment engagement. METHODS: In Aim 1, we will perform analyses on 1060 YPWID initiating MOUD treatment across 8 ICCs to determine predictors of sustained MOUD treatment engagement and quantify time to treatment drop- out. In Aim 2, we will conduct focus group discussions and individual interviews with key stakeholders (YPWID, caregivers, and providers) involved in MOUD treatment to identify themes that inform youth-specific content modifications to Life-Steps. RESULTS: Pending. IMPACT: Following completion of these aims, I will evaluate Youth Life-Steps in a pilot randomized clinical trial, testing the hypothesis that participation in Youth Life-Steps will result in sustained MOUD treatment engagement among YPWID thereby leading to reduced substance use and improved HIV outcomes. In countries worldwide facing opioid crises, including the U.S, HIV incidence is concentrated in YPWID who also encounter significant barriers to substance use treatment. There are few youth-tailored telehealth interventions to address these barriers. My research while addressing a critical public health gap in India will also offer lessons for other resource-limited countries and rural US communities facing major opioid epidemics.