Infectious Disease · Psychiatry ·
Mobile Integrated PrEP and MOUD Services Did Not Improve Use in Randomized Trial
A randomized trial of 409 people who inject drugs across five US cities compared mobile delivery of integrated HIV prevention and opioid use disorder treatment with peer navigation to community services. At 26 weeks, confirmed PrEP and MOUD use did not differ significantly between groups; fewer deaths occurred in the mobile-service group, a finding the authors say needs replication.
- Randomized trial enrolled 409 people who inject drugs.
- Mobile services did not improve PrEP or MOUD use.
- Fewer deaths occurred in the intervention group.
- Authors say the mortality finding needs replication.
This open-label, two-group randomized clinical trial enrolled 409 adults who injected drugs, did not have HIV, had opioid use disorder, and were not taking medication for opioid use disorder (MOUD). Participants in Houston, Los Angeles, New York, Philadelphia, and Washington, DC, received 26 weeks of either peer navigation plus integrated PrEP and MOUD services on a mobile unit (203 participants) or peer navigation to existing community services (206 participants). The co-primary outcomes were PrEP and MOUD use at 26 weeks.
At 26 weeks, confirmed PrEP use was 5.4% with mobile services and 2.9% with community referrals; MOUD use was 14.8% and 10.7%, respectively. The groups also had similar confirmed use at 52 weeks. Three HIV acquisitions occurred overall. By 52 weeks, four deaths were confirmed in the intervention group and 13 in the control group (hazard ratio, 0.29; 95% CI, 0.1-0.9; P=.03).
The mobile model did not improve the primary outcomes compared with peer navigation alone. The mortality difference is notable but requires replication; the abstract does not establish why deaths differed. Low observed PrEP and MOUD use also limits conclusions about the model’s effectiveness in increasing uptake.
In practice
For adults who inject drugs and have opioid use disorder, this trial found that adding mobile, integrated PrEP and MOUD delivery to peer navigation did not significantly increase confirmed use of either treatment compared with navigation to community services. The result does not support assuming that mobile integration alone will improve uptake. A lower number of deaths in the mobile-service arm was observed, but the study does not establish the reason for this difference, and the authors call for replication before drawing practice conclusions.
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JAMA Psychiatry: Mobile Units for Integrated Addiction and HIV Prevention Services for People Who Inject Drugs ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.