Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life With HIV and Substance Use (ePORTAL-HIV-S)

The University of Chicago

Status: Active, not recruiting

Conditions: Substance Use Disorders; Hiv

Treatments: Behavioral: Population level patient portal based substance involvement screening; Behavioral: Usual Care Substance Use Involvement Screening

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06682468

IRB24-0684

R01DA058965 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This study aims to achieve health equity in substance use disorder (SUD) screening and treatment among Black people living with human immunodeficiency virus (HIV) by implementing interventions to decrease barriers to screening (clinic-based, in-person) and treatment (referral-focused), a program the study investigators call Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life With HIV and Substance Use (ePORTAL HIV-S). The ePORTAL HIV-S randomized control trial will focus on portal-based screening in the HIV clinic, regardless of whether the patient has a scheduled appointment with their HIV provider. The study includes a clinic-based treatment program implemented at the Chicago Department of Public Health-funded South Side Health Home (S2H2), the main provider of HIV prevention and care services for Chicago's South Side.

Full description

Substance use disorder (SUD) and human immunodeficiency virus (HIV) are synergistic epidemics (syndemics) disproportionately affecting Black Americans. Structural racism related to inadequate access to healthcare, stigma, and criminalization, especially among those with intersectional identities related to gender and sexual minorities, further exacerbate disparities in HIV and SUD outcomes.

SUD is often unrecognized and untreated among people living with HIV (PLWH). Only about half of HIV care sites routinely screen and refer to SUD treatment. In preliminary work, the study investigators found that nearly half of patients assessed in an HIV clinic waiting room met the criteria for an SUD, but 65% had not been diagnosed with SUD. A promising strategy to address structural barriers to SUD screening for PLWH is use of electronic patient portals. Patient portals are secure websites that give patients access to health information and allow for secure messaging with providers. They are associated with improved health outcomes and patient engagement. Notably, while most SUD screening currently occurs during clinic visits, portals can be utilized for SUD screening to reach patients who miss clinic visits, which is more common among people with HIV and SUD. The study team's preliminary work has demonstrated the potential of the portal for use in a population health approach to behavioral health screening.

This study will implement and evaluate multi-level interventions to decrease barriers to SUD screening (clinic-based, in-person) and treatment (referral-focused), a program the study investigators call Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life With HIV and Substance Use (ePORTAL HIV-S). ePORTAL HIV-S is conducting a randomized control trial to assess the effectiveness of population health vs. usual (clinic-visit) SUD screening among PLWH in an HIV clinic. The randomized control trial will be conducted at the Chicago Department of Public Health-funded South Side Health Home (S2H2), the main provider of HIV prevention and care services for Chicago's South Side. The ePORTAL HIV S study will also include a referral to a clinic-based treatment.

Enrollment: 900 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 years or older
• has been diagnosed with human immunodeficiency virus infection (HIV)
• provider has assented
• receives HIV care at the UCM Ryan White Adult HIV Care Clinic in DCAM, as evidenced by inclusion in the Epic HIV Registry
• speaks English
• has not completed in clinic SUD screening in the last year
• has an active MyChart account

Exclusion criteria

• Patients who have been screened for substance use disorder at the clinic in the last year using the NIDA Quick Screen
• Patient's provider has not assented to the intervention
• Patient is younger than 18 years

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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900 participants in 2 patient groups

Patient portal population level substance involvement risk screener

Experimental group

Description:

Participants randomized to this group will receive a National Institute on Drug Abuse (NIDA) Quick Screen V1.0 substance involvement screener over the patient portal regardless of having a scheduled appointment with their HIV clinician. If they do not complete the screener via the portal, they will be screened at HIV clinic appointments.

Treatment:

Behavioral: Population level patient portal based substance involvement screening

Usual Care SUD Screening

Other group

Description:

Participants randomized to this intervention will receive the NIDA Quick Screen V1.0 if they attend their scheduled appointment with their HIV clinician.

Treatment:

Behavioral: Usual Care Substance Use Involvement Screening