PROJECT SUMMARY The availability of antiretroviral therapy (ART) has markedly reduced HIV-related mortality and morbidity in Africa. Yet HIV remains the leading cause of death among adult men and women in South Africa due fails to initiated ART or remain in care. Between 2 and 3% of HIV-infected men in South Africa pass through the corrections system annually. During incarceration uptake of ART is excellent; unfortunately, during community re-entry most individuals who were on ART are lost from care. Qualitative and quantitative research conducted by this research group in South Africa indicates that this population encounters multiple barriers to care engagement. These barriers include lack of patient-centered care, family abandonment and limited social capital, enacted stigma, economic insecurity, and substance use. More than 55% of community re-entrants report illicit opioid use; this appears to the leading cause of loss from care. An evidence-based approach to help management this issue is long-term medication-assisted treatment (MAT) of substance use. In South Africa, methadone and buprenorphine/naloxone are available but have never been used specifically for re-entrants. This project seeks to characterize the needs of dual diagnosed re-entrants, their journey, and key components of implementing a MAT program for this population. We propose to recruit a cohort of 40 dual- diagnosed inmates, offer opioid use services and HIV linkage to care and follow them for 6 months post release. Post-release follow-up will include longitudinal in-depth interviews to generate a rich understanding of the dynamic process or community re-entry for dual-diagnosed inmates. This includes their relationships with opioid use and with opioid use management services. We will also interview key stakeholders to develop a clear understanding of implementation needs and convene workshops to reflect on findings with stakeholders, including dual diagnosed ex-inmates, to develop a feasible and acceptable working model for substance use management in this population. The current proposal will allow for the adaptation of an existing community MAT and harm reduction program to fit the needs of re-entrants. This project has the potential to develop considerable new knowledge on an population that has received little attention – dual diagnosed individuals in South Africa and community re-entrants in general.