This study aims to improve health care for people who may have HIV or substance use disorders by bringing two services to a large community health center in Chicago. First, the clinic will begin offering routine screening for substance use to all patients. Second, the study will offer a social network-based program that helps people identify friends or partners who may need support and link them to care. The goal is to help more people learn their HIV status, reduce HIV levels in the community, and connect people with substance use treatment when needed. The study will also look at how well these services can be added into everyday clinic practice and what is needed to keep them going over time.
This project will take place in a network of federally qualified health centers that serves communities in Chicago that experience some of the highest rates of new HIV infections. The study has two main parts: Routine Substance Use Screening and a Social Network Intervention (SNI). Routine screening at the clinics will introduce a consistent, standardized way to ask patients about substance use during regular visits. Patients who screen positive will be offered help, referrals, and follow-up services. The social network intervention asks patients to think about people in their social networks (such as partners, friends, or peers) who may have untreated HIV, may have fallen out of care, or may have substance use concerns. Participants will receive support and tools to help connect people in their network to HIV testing, care, and treatment or substance use services at these clinics. Together, these activities aim to: * Identify people who have HIV but are not in care * Reduce HIV viral load levels in the community * Identify people with substance use disorders and link them to treatment * Improve access to supportive services in the community The study will also examine how easy or hard it is for clinics to use these two strategies in everyday practice. Researchers will gather feedback from clinic staff and patients to understand what helps or gets in the way of using these services in the long term. The goal is to create a package of tools and processes that other clinics can adopt in the future.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
500
Implement a routine SUD screening at the FQHC.
Social network intervention (SNI) to identify individuals who are viremic, have SUD, or both and link them to harm reduction and HIV continuum of care services. There are three main activities that make up the SNI: 1) recruiting, screening, and interviewing "index participants"; 2) training the index participants to recruit others; 3) screening and interviewing persons who present a valid recruitment voucher given to them by an index participant.
Howard Brown Health
Chicago, Illinois, United States
Rate of Substance Use Disorder (SUD) Detection
The number and proportion of patients who screen positive for substance use disorder using the routine SUD screening tool (NIDA Quick Screen) compared with the number identified through existing electronic medical record (EMR) documentation. This outcome measures whether routine screening increases the detection of individuals with possible SUD.
Time frame: Baseline through 24 months
Number of Individuals Identified as Viremic and/or Having SUD Through the Social Network Intervention (SNI)
The number of people identified through the Social Network Intervention who have unsuppressed HIV (viremia), substance use disorder, or both. This will be compared to a functional control group (new or re-engaged clinic patients during the same time period) to determine whether the SNI is more effective at finding high-priority individuals needing care.
Time frame: Baseline through 24 months
Linkage to HIV Care or Substance Use Services
The proportion of individuals identified through SUD screening or the SNI who successfully link to harm reduction, HIV care, or substance use treatment services. This outcome assesses early engagement in care following identification.
Time frame: Baseline through 24 months
Viral Suppression Among Individuals Identified Through Screening or SNI
The proportion of people identified with HIV who achieve viral suppression after being linked to care. This measures the downstream impact of improved identification and engagement.
Time frame: Baseline through 24 months
Time to Linkage to HIV Care or Substance Use Services
The number of days from identification (via SUD screen or SNI) to the first attended HIV care appointment, harm reduction service, or substance use treatment visit.
Time frame: Baseline through 24 months
Number of New HIV Diagnoses Identified Through the SNI
The number of individuals identified by SNI participants who test positive for HIV and were previously undiagnosed.
Time frame: Baseline through 24 months
Substance Use Treatment Initiation
The proportion of people identified with SUD who initiate counseling, medication-assisted treatment, or other substance use services.
Time frame: Baseline through 24 months
Re-engagement in HIV Care
The number and proportion of individuals previously out of care for ≥6 months who return for at least one HIV medical visit after identification.
Time frame: Baseline through 24 months
Acceptability of SUD Screening and the SNI
Acceptability scores based on surveys and interviews with clinic staff and participants, assessing satisfaction, perceived burden, and overall fit within the clinical setting.
Time frame: Measured at Months 6, 12, 18, and 24
Feasibility of Implementing the SUD Screener and SNI
Assessment of whether the interventions can be carried out in the clinic as intended, measured by workflow fit, completion rates, and staff-reported ease of implementation.
Time frame: Baseline through 24 months
Sustainability of Screening and SNI Workflows (EPIS: Sustainment Phase)
Indicators of ongoing use of SUD screening and SNI processes without external study support, including continued staff utilization and workflow integration.
Time frame: Measured at 24 months
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