Clinical Scorecard: Mobile medical units providing integrated care were associated with fewer deaths among people who inject drugs and are at risk for HIV

At a Glance

Key Highlights

• In the 409-participant HPTN 094 trial, the mobile-unit intervention was associated with 71% lower all-cause mortality than peer navigation linking participants to community services.
• The intervention lasted 26 weeks and integrated peer navigation, PrEP, medication for opioid use disorder, and limited clinical and supportive services.
• The study found no between-group difference in daily oral PrEP use or medication for opioid use disorder utilization.
• Verified PrEP uptake was low in both groups at week 26.
• Fourteen percent of participants were using medication for opioid use disorder at both weeks 26 and 52, despite none using it at enrollment.

Guideline-Based Recommendations

Diagnosis

Management

• The mobile-unit intervention provided integrated HIV prevention and substance use disorder services with peer navigation for 26 weeks.
• The comparison approach used peer navigation to link participants with available community-based services.

Monitoring & Follow-up

• Study outcomes included daily oral PrEP use, medication for opioid use disorder utilization, and all-cause mortality.
• Medication for opioid use disorder use was assessed at weeks 26 and 52.

Risks

• The article identifies barriers to access and continuity of care, including fragmented services, housing instability, and stigma.
• Researchers reported that oral PrEP was used relatively infrequently and that PrEP acceptance presents substantial challenges for people who inject drugs.

Patient & Prescribing Data

HPTN 094 enrolled 409 adults without HIV who injected drugs, had opioid use disorder, were not receiving medication for opioid use disorder at enrollment, and were willing to consider it.

The mobile-unit arm offered peer navigation, PrEP, medication for opioid use disorder, and limited clinical and supportive services. No between-group difference was observed in daily oral PrEP use or medication for opioid use disorder utilization.

Clinical Best Practices

• Study co-chair Nabila El-Bassel said findings demonstrate the need to create care models that reach people where they are and link HIV prevention, addiction treatment, and supportive services.
• Researchers emphasized assessing long-acting PrEP formulations specifically in people who inject drugs.
• The article states that replication of the findings remains necessary.

Related Resources & Content

• NIH: Integrated health service delivery through medical mobile units helped to reduce deaths among individuals at risk for HIV who also inject drugs