A Study Protocol to Increase Engagement in Evidence-Based Hospital and Community-Based Care Using a Serious Injection-Related Infections Checklist and Intensive Peer for Hospitalized PWID (ShaPe)

Abstract

With the ongoing drug crisis, serious injection-related infections (SIRIs), such as endocarditis, have increased significantly. Hospitalizations are a missed opportunity for persons who inject drugs (PWID) to engage in care. We developed a 5-item SIRI Checklist for providers as a standardized reminder to offer medication for opioid use disorder (MOUD), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) screening, harm reduction, and referral to community-based care. We formalized an Intensive Peer Recovery Coach protocol to support PWID on discharge. We hypothesized that the SIRI Checklist and Intensive Peer Intervention would increase HIV and HCV screening, MOUD, and linkage to care: pre-exposure prophylaxis (PrEP) prescription, MOUD prescription, and related outpatient visit(s). This is a feasibility study and randomized control trial of a Checklist and Intensive Peer intervention for hospitalized PWID with SIRI. We will randomize 60 PWID into 4 groups (SIRI Checklist, SIRI Checklist + Intensive Peer, Intensive Peer, and Standard of Care). Results will be analyzed using a 2 × 2 factorial design. Outcomes include the ability to recruit and retain hospitalized PWID and clinical data (HIV, HCV testing, MOUD, and PrEP prescriptions). By testing low-barrier interventions that are accessible and reproducible in a rural, poor state, we aim to identify models of care that promote linkage and engagement in community care.

Keywords: HIV; PrEP; addiction; hospitalization; opioid substance treatment; protocol; rural; southern.