NIH trial finds mobile units cut deaths by 71%

The National Institutes of Health on Wednesday reported that an NIH-funded clinical trial found mobile medical units reduced all-cause deaths by 71% among adults at risk for HIV who also inject drugs.

The units delivered integrated HIV and substance use disorder services with peer navigation. Participants who received those services had fewer deaths than participants who received peer navigation to community-based services alone. Scientists found no difference between the groups in use of daily, oral preexposure prophylaxis, known as PrEP, or medication for opioid use disorder, known as MOUD, but the lower death rate was significant.

The trial, known as HIV Prevention Trials Network Study 094, enrolled 409 adults without HIV who injected drugs and had opioid use disorder. None were taking MOUD at enrollment, and all were willing to consider it. It took place in Houston, Los Angeles, New York City, Philadelphia and Washington, D.C.

One group received 26 weeks of peer navigation plus integrated PrEP, MOUD, and limited clinical and supportive services on a mobile unit. The other group received 26 weeks of peer navigation that linked participants to available community services that were not mobile. Five mobile health clinics were deployed for the study.

Verified PrEP use was low for both groups at 26 weeks, though the National Institutes of Health said it was favorable compared with self-reported use among people who inject drugs. There was no difference in MOUD use between the study arms. The release said 14% of people used MOUD at 26 weeks and at 52 weeks, a clinically meaningful level because none were on MOUD at the start.

Nora D. Volkow, M.D., director of the National Institute on Drug Abuse, which funded the study, said injection drug use is an important contributor to HIV in the United States and also increases risk for other serious infectious diseases. “Nonetheless, these findings suggest that delivering low threshold services through mobile units could save lives,” Volkow said.

Nabila El-Bassel, Ph.D., the Willma and Albert Musher Professor of Social Work at Columbia University and a study co-chair, said people who inject drugs often face fragmented systems, unstable housing, stigma and other barriers that make sustained care difficult. Steven Shoptaw, Ph.D., the George F. Kneller Endowed Chair in Family Medicine and vice chair for Research in the UCLA Department of Family Medicine, also served as study co-chair.

According to researchers, the relatively low use of oral PrEP, even with structured peer navigation, shows that PrEP uptake has major challenges for acceptance among people who inject drugs. They said that points to the importance of evaluating long-acting PrEP formulations in this population. The National Institutes of Health said mobile units may help overcome significant barriers to accessing HIV and addiction treatment, but replication is needed.

The HIV Prevention Trials Network is sponsored by the National Institute of Allergy and Infectious Diseases, and the trial was funded by the National Institute on Drug Abuse. The findings appear in JAMA Psychiatry.