The 'Expanded HIV care in opioid substitution treatment' (EHOST) cluster-randomized, stepped-wedge trial: A study protocol.
The public health response to HIV/AIDS has turned its focus onto optimizing health care system delivery to maximize case identification, access and sustained engagement in antiretroviral treatment (ART). Opioid Agonist Treatment (OAT) provides a critical opportunity for HIV testing and linkage to ART. The EHOST study is a cluster-randomized, stepped-wedge trial to evaluate a prescriber-focused intervention to increase HIV testing rates, and optimize ART engagement and retention outcomes among individuals engaged in OAT. The study will encompass all drug treatment clinics currently admitting patients for the treatment of opioid use disorder across the province of British Columbia, encompassing an estimated 90% of the OAT caseload. The trial will be executed over a 24-month period, with groups of clinics receiving the intervention in 6-month intervals. Evaluation of the proposed intervention's effectiveness will focus on three primary outcomes: (i) the HIV testing rate among those not known to be HIV positive; (ii) the rate of ART initiation among those not on ART; and (iii) the rate of ART continuation among those on ART. A difference-in-differences analytical framework will be applied to estimate the intervention's effect. This approach will assess site-specific changes in primary outcomes across clusters while adjusting for potential residual heterogeneity in patient case mix, volume, and quality of care across clinics. Statistical analysis of outcomes will be conducted entirely with linked population-level administrative health datasets. Facilitated by established collaborations between key stakeholders across the province, the EHOST intervention promises to optimize HIV testing and care within a marginalized and hard-to-reach population.
BC Centre for Excellence in HIV/AIDS, Canada; Faculty of Health Sciences, Simon Fraser University, Canada. Electronic address: bnosyk@cfenet.ubc.ca.
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B
Nosyk
BC Centre for Excellence in HIV/AIDS, Canada.
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Krebs
BC Centre for Excellence in HIV/AIDS, Canada.
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JE
Min
BC Centre for Excellence in HIV/AIDS, Canada.
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K
Ahamad
BC Centre for Disease Control and Prevention, Canada; School of Population and Public Health, University of British Columbia, Canada.
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J
Buxton
Faculty of Health Sciences, Simon Fraser University, Canada.
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C
Goldsmith
BC Centre for Excellence in HIV/AIDS, Canada; Vancouver Coastal Health Authority, Canada.
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M
Hull
Vancouver Coastal Health Authority, Canada.
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Joe
BC Centre for Disease Control and Prevention, Canada.
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Krajden
BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada.
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VD
Lima
BC Centre for Excellence in HIV/AIDS, Canada.
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M
Olding
BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada.
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Wood
BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada.
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JSG
Montaner
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001955:British Columbia; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008403:Mass Screening; D055118:Medication Adherence; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012107:Research Design; D015819:Substance Abuse, Intravenous / Q000188:drug therapy*
D019380:Anti-HIV Agents
Antiretroviral treatment; Cluster-randomized; HIV; Opioid Agonist Treatment; Stepped-wedge