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Poster describing a study that examined type-specific medications for opioid use disorder (MOUD) awareness (i.e., heard of) and referral willingness among CBO providers and clients. The data was acquired via cross-sectional survey of 13 Southern U.S. CBOs in FL, GA, LA, MS, and TN. Analysis revealed that compared with methadone, buprenorphine and naltrexone awareness is lower for both providers and clients, though providers are more aware of all types of MOUD than clients. Additionally, providers report greater willingness to refer for buprenorphine and naltrexone than clients report willingness to be referred (especially for naltrexone).

This type of misalignment can hinder MOUD uptake, weaken provider-client linkage, and contribute to high overdose rates and limited provider and MOUD access in the South.

Related protocols: CTN-0082

Substance use can be a coping mechanism during stressful times. The United States opioid crisis worsened during the COVID-19 pandemic. This study looks at the effects of the pandemic on self-reported change in drug and alcohol use and medications for opioid use disorder (MOUD) and naloxone interest in a population and region hit hard by the opioid crisis—people who use illicit opioids (PWUO) and other drugs in the Southern United States. Cross-sectional data came from the National Institute on Drug Abuse Clinical Trials Network survey study CTN-0082. During the pandemic, participants (N=381) completed a survey about their pandemic-attributed increase, decrease, or no change in use of opioids, non-opioid drugs, or alcohol and interest in MOUD and naloxone. Data were analyzed using multinomial logistic regressions; regression models included potential contributing factors like sociodemographics, substance use frequency, and psychological distress. Results showed that most participants reported no change in: use of opioids (54%), non-opioid drugs (59%), or alcohol (64%) and interest in MOUD (60%) or naloxone (72%). Factors related to no change in relation to change in substance use and/or service interest included past 12-month substance use frequency, race, ethnicity, age, sex, and education.

Conclusions: We conclude that the lack of change in drug use and interest in MOUD and naloxone suggests stability amidst challenging times in our sample of PWUO in the Southern United States. Differences in outcomes based on sociodemographics and substance use frequency indicate the need for tailored services during future public health emergencies.

Related protocols: CTN-0082

The COVID-19 pandemic exacerbated health challenges among people who use opioids (PWUO) and substance using men who have sex with men (SU-MSM) in Southeastern United States cities. Within the larger NIDA Clinical Trials Network Protocol 0082 PrEP attitudes and opioid use services implementation survey, N=171 PWUO and N=169 SU-MSM answered a COVID-19 vaccine attitudes survey, including measures of vaccine willingness and health beliefs. In mixed-effects linear models for PWUO and SU-MSM, respectively: (1) belief in vaccine protection from illness was positively correlated with vaccine willingness; and (2) sense of being “a guinea pig” was negatively correlated with vaccine willingness. Having previously used a COVID-19 antigen test was positively correlated with vaccine willingness in SU-MSM. This study aims to define vaccine willingness during the COVID-19 pandemic among people who use drugs and proposes the use of the Health Belief Model to conceptualize the correlation between health beliefs and intended behaviors.

Related protocols: CTN-0082

This study applied the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) to assess predictors of willingness to use three medications (methadone, buprenorphine, naltrexone) for opioid use disorder (MOUD), among people who use opioids (PWUOs). A single assessment survey, with measures aligned to the TRA/TPB were administered to 235, majority male, predominately White, PWUOs attending syringe services programs (SSPs) in the Southeastern United States, administered as part of CTN-0082. Hierarchical multiple regressions were used to analyze predictors of willingness to take each type of MOUD.

Conclusions: Findings partially supported the TRA but not TPB, with positive attitudes associated with greater willingness to use all three types of MOUD: pinpointing to the value of SSPs as a low threshold hub for treatment engagement.

Related protocols: CTN-0082

Southern U.S. communities experience high HIV incidence and substance use prevalence, yet low PrEP uptake. In CTN-0082, providers (N=191) completed a survey about willingness to refer/link clients with HIV risk to PrEP. Through in-depth interviews, 12 directors (5 sexually transmitted infection [STI] clinics; 5 syringe services programs [SSPs]; 2 substance use treatment programs [SUTPs]) described multi-level factors that contextualized provider willingness. Providers were more willing to refer/link clients with unspecified HIV risk and men who have sex with men to PrEP vs. other populations. SUTP (vs. SSP) providers were less willing to refer/link clients with unspecified risk and men who use opioids. Older (vs. younger) providers were less willing, and more (vs. less) experienced providers more willing to refer/link to PrEP. Directors described facilitators (e.g., comprehensive health center partnerships) and barriers (e.g., provider stigma toward people who use drugs) to PrEP implementation. Findings highlight the importance of considering multi-level factors in PrEP implementation.

Related protocols: CTN-0082

Men who have sex with men who use substances (SU-MSM) can benefit from pre-exposure prophylaxis (PrEP) for HIV prevention, especially in Southern US cities where HIV incidence is high; however, uptake remains low. Identifying barriers and facilitators is crucial for developing and implementing strategies to enhance uptake. Few studies of PrEP barriers and facilitators have focused on Southern SU-MSM, and most existing studies have not robustly measured such barriers and facilitators. In this study, 225 SU-MSM were recruited from community STI clinics, syringe services programs, or substance use treatment programs in eight Southern cities. Using structural equation modeling, we examined latent variable constructs of barriers and facilitators (i.e., affordability, burden, risk compensation, side effects, and stigma) and their associations with both willingness to take PrEP and length of PrEP use. Greater concern over affordability was robustly associated with more willingness to take PrEP under a variety of conditions. Risk compensation was associated with greater length of PrEP use, suggesting a major motivator to remain on PrEP was the perceived freedom to forego condoms during sex. Findings advance research on measurement of barriers and facilitators of PrEP willingness and uptake and highlight the importance of addressing affordability in PrEP implementation.

Related protocols: CTN-0082

Background: The opioid epidemic presses on as a significant public health issue in the U.S., with particularly high overdose death rates in the Southeast. Naloxone is the standard of care for reversing opioid overdose; however, many people who use drugs (PWUD) experience barriers to naloxone use. This cross-sectional survey study aims to describe awareness of, experience with, willingness, barriers, and distribution strategies for naloxone among PWUD in the Southeast.

Methods: Data were obtained from a larger implementation survey study (CTN-0082). Descriptive analyses focused on N = 381 people in substance use treatment programs, syringe services programs, and sexually transmitted infection clinics who reported non-prescription opioid use in the past 12 months and completed a naloxone-related questionnaire.

Results: Most PWUD reported using opioids daily (60–62 %). 82 % had previously heard of naloxone, but only 43 % reported having received any type of training to use it. On a 5-point scale, PWUD without prior training (n = 219) reported being very willing to be trained to use naloxone on someone who overdoses (Mdn=5.00, IQR=2.00). Among all PWUD, not knowing where to go for naloxone training was the only barrier to using naloxone that was endorsed with certainty (Mdn=4.00, IQR=2.00). PWUD endorsed three strategies to improve naloxone distribution, including wanting their site to offer naloxone training (Mdn=4.00, IQR=1.00), increased access to naloxone education (Mdn=4.00, IQR=1.00), and connecting people to training programs (Mdn=4.00, IQR=1.00).

Conclusion: This study suggests that improvements are still needed in the saturation of naloxone training and distribution among PWUD, including in settings that provide non-opioid related services.

Related protocols: CTN-0082

This is one of the primary outcomes articles for CTN-0082.

In Southern U.S. states with high HIV incidence and low HIV Pre-Exposure Prophylaxis (PrEP) uptake, enhanced efforts to increase interest in and willingness to use PrEP are needed. This implementation survey examined the associations of sociodemographic background, substance use, and sexual risk behaviors with willingness to use daily oral and long-acting injectable (LAI) PrEP among substance using men who have sex with men (SU-MSM). Participants were 225 SU-MSM recruited from sexually transmitted infection (STI) clinics, syringe services programs (SSPs), and substance use treatment programs (SUTPs) in eight Southern U.S. cities. Rates of willingness were high for both daily oral PrEP (78%) and LAI PrEP (66%). In multivariable analyses, distinct factors were associated with willingness towards each. For daily oral PrEP, greater willingness was associated with condomless anal sex, less frequent non-injection opioid use, prior PrEP awareness, and past use of PrEP. For LAI PrEP, greater willingness was associated with Black race, identifying as gay, being single, and higher injection drug use frequency. Lower willingness to use LAI PrEP was associated with higher non-injection opioid use frequency. Findings about willingness to use LAI PrEP, as a relatively newer modality, and greater willingness among Black SU-MSM as a disproportionately HIV-impacted population, are especially important.

Conclusions: These findings argue for the necessity to enhance PrEP promotion efforts that distinguish between oral and LAI PrEP and that are specifically tailored to major SU-MSM subgroups in the Southern U.S.

Related protocols: CTN-0082

This is one of the primary outcomes articles for CTN-0082.

People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study, CTN-0082 (Implementation Survey of PrEP and Opioid Use Related Services in STI Clinics and Community Based Organizations), examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence.

HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models.

Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex.

Conclusions: PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP.

Related protocols: CTN-0082