PROTECT: Prevention and Remote Outreach for Treatment and Engagement in Care through Telehealth

About This Grant

People involved in the criminal legal system (CLS) experience disproportionately high risk for exposure to HIV, yet access to PrEP for HIV prevention remains severely limited, particularly in jail settings. Standard approaches, such as education and passive referrals, have proven ineffective in engaging recently released individuals in PrEP care, highlighting the need for targeted interventions to promote continuity of care. To close this gap, we propose testing the Comprehensive Tele-Health concieRge (C-THR) model, a telehealth-based, peer-driven intervention proposed to improve PrEP initiation and retention among people with histories of drug use exiting county jails. C-THR applies patient-centered care at multiple levels: (1) System-level; (2) Interpersonal-level; and (3) Individual-level. C-THR has already demonstrated high acceptability, feasibility, and preliminary efficacy in improving HIV viral suppression and retention on buprenorphine among individuals with opioid use disorder. This randomized controlled trial (RCT) will assess the efficacy, cost-effectiveness, and implementation feasibility of C-THR to inform scalable, evidence-based approaches for increasing PrEP access for people in jail. The specific aims are: Aim 1: Evaluate the efficacy of C-THR compared to standard of care (patient navigation) in improving PrEP adherence and persistence (primary outcome; tenofovir detection in urine samples) and drug treatment engagement (secondary outcome; participation in medications for opioid use disorder, other pharmacotherapies, cognitive behavioral therapy, or group counseling). Aim 2: Conduct an economic evaluation of C-THR, assessing both budgetary impact and cost-effectiveness to inform future local and national implementation efforts. Aim 3: Identify key facilitators to C-THR implementation and evaluate how these factors influence fidelity, reach, and overall effectiveness, ensuring that findings can be translated into sustainable policy and practice. This study will provide critical insights into the scalability and effectiveness of telehealth models in increasing PrEP uptake and improving continuity of care for CLS-involved populations.