# PWID Opportunities to Improve TrEat and Retain (POINTER)

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $864,464

## Abstract

7. PROJECT SUMMARY/ABSTRACT
People who inject drugs (PWID) are at high risk for HIV infection and experience worse treatment outcomes
than other key populations, particularly in low to middle income countries (LMIC). Opioid use is common in
India and new injection drug epidemics have emerged in the North and Central regions of the country in the
last 5-10 years. In these regions, we have documented high rates of needle sharing, high HIV prevalence and
incidence, and low access to HIV testing and treatment. Our team demonstrated the potential of respondent-
driven sampling (RDS) to leverage social networks and identify unaware and out-of-care HIV-positive PWID. In
response to RFA-DA-18-017, we propose to build on our experience with RDS as the foundation of
“seek and test”, by rigorously assessing three scalable strategies aimed at improving the “treat and
retain” steps of the HIV care continuum among PWID in a LMIC setting. Aim 1 is to conduct a factorial
randomized controlled trial to evaluate the individual and combined effects of a policy intervention (same-day
ART), a structural intervention (community-based care) and an individual-level intervention (psychosocial/
navigation) to improve treatment outcomes among HIV-positive PWID. A factorial design can assess both the
main effects of multiple interventions and interactions between the interventions, offering the potential for trial
efficiency (effectively getting 3 trials for the price of one) and novel insights on how interventions with different
mechanisms may influence the effectiveness of one another. We will test 3 hypotheses: Hypothesis 1A -
Same-day ART initiation will increase 12-month survival with viral suppression among HIV-positive PWID,
compared with standard ART initiation. Same-day ART has been found effective in Africa, but has never been
evaluated in PWID. Hypothesis 1B - Community-based care will increase 12-month survival with viral
suppression among HIV-positive PWID, compared with government-based care. In prior work, we found that
PWID-centric integrated care centers (ICCs) were highly effective at engaging the population, providing opioid
treatment and increasing HIV testing uptake. Here we propose to scale-up the ICC model to provide
community-based HIV care in an accessible and non-discriminatory setting. Hypothesis 1C - A
psychosocial/navigation intervention (enhanced support) will increase 12-month survival with viral suppression
among HIV-positive PWID, compared with standard support. Patient navigators will provide PWID-focused
motivational interviewing, skills building, and field-based systems navigation and retention. We propose to
adapt and build upon evidence-based interventions for PWID. Durability of intervention effects will be assessed
at 18 months. Aim 2 is to characterize the barriers and facilitators to implementation of the proposed
interventions, and determine the intervention costs and potential cost-effectiveness. We will characterize
implementatio...

## Key facts

- **NIH application ID:** 9823107
- **Project number:** 1R01DA049301-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** GREGORY M LUCAS
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $864,464
- **Award type:** 1
- **Project period:** 2020-09-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9823107

## Citation

> US National Institutes of Health, RePORTER application 9823107, PWID Opportunities to Improve TrEat and Retain (POINTER) (1R01DA049301-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9823107. Licensed CC0.

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