Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study

Abstract

Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP. Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy. Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]). Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care. KEY MESSAGES The Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program setting Using telehealth was associated with increased three-month buprenorphine retention Baseline stimulant use was negatively associated with three-month buprenorphine retention

Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services

“…In our previous work interviewing PWID to determine how to best deliver comprehensive HIV prevention to this community, our SSP participants advocated for a “one-stop shop” where PrEP and MOUD would be delivered via an SSP with evidence-based harm reduction interventions of syringes and naloxone [ 112 ]. In our pilot (n = 109), we adapted the THR intervention to offer low barrier, free buprenorphine at the SSP with promising results of 59% retention at 3 months [ 113 ]. Building on this work, we now seek to adapt and test the C-THR intervention for PWID to address their HIV prevention and substance use needs more fully.…”

Health, harm reduction, and social service providers’ perspectives on the appropriateness and feasibility of peer distribution of HIV self-test kits among people who use drugs

“…Digital interventions have been developed to support service linkage following HIVST [ 65 ], yet PWUD most vulnerable to HIV often lack consistent phone and Internet access [ 66 – 68 ]. Alternatively, models such as “tele-harm reduction” incorporating tele-health and peer support could support linkage to and retention in comprehensive HIV prevention and treatment services following HIVST [ 69 , 70 ]. Despite these concerns, however, our findings echo a recent scoping review concluding that HIVST is generally preferred in at-risk populations over traditional facility-based HIV testing [ 71 ].…”