Substance Use
Integrating Telehealth into Syringe Service Programs to Improve HIV Prevention Among People Who Use Drugs Jessica Beetch* Jessica Beetch Beetch Beetch University of Minnesota
Background: People who use drugs (PWUD) experience disproportionate HIV risk yet face persistent structural barriers to prevention and care, including stigma, limited access to specialty providers, and challenges navigating health systems. Syringe service programs (SSPs) are trusted community-based harm reduction settings that provide sterile injection supplies and other preventive services and may facilitate alternative care delivery models.
Methods: We launched a National Institutes of Health–funded pilot study evaluating a telehealth intervention integrated within four SSPs in Minnesota, USA. The intervention aims to improve access to HIV prevention and related services by (1) connecting PWUD to clinicians trained in infectious disease and addiction medicine, (2) providing case management support for healthcare navigation and insurance enrollment, and (3) implementing trauma-informed care training and structural protocol changes to reduce stigma. During Phase 1, we conducted formative qualitative research to inform intervention design. Two trained interviewers conducted semi-structured interviews with 30 racially and geographically diverse PWUD recruited from the four participating SSPs. Interviews lasted approximately 60 minutes and participants received cash compensation for their time and expertise. Audio-recorded interviews were transcribed verbatim and coded in Dedoose using a dual-coder approach to identify recurring themes.
Outcomes: Key themes included lack of provider understanding of substance use, experiences of judgment and stigma in healthcare settings, and reports of being denied pain management or adequate care due to their drug use history. Participants also identified multiple barriers to healthcare access including transportation challenges, unstable housing, long wait times, limited access to working phones, and lack of health insurance coverage. Notably, awareness of pre-exposure prophylaxis (PrEP) differed by geographic location. While 59% of participants in urban settings reported having heard of PrEP, only 15% of participants in rural settings reported PrEP awareness.
Conclusions: Findings from this formative phase highlight the importance of community-informed intervention design and emphasize the need for services that meet PWUD where they are both physically and emotionally within trusted harm reduction settings. By embedding telehealth services within SSPs, this study evaluates a health system–level approach to improving HIV prevention and care access for PWUD. Findings will inform scalable strategies to reduce HIV-related disparities in populations disproportionately affected by structural barriers and healthcare stigma.