Barriers to Recruitment of HIV+ Individuals with OUD in the CHOICES Trial
Substance use disorders (SUD) are common in individuals with HIV, and untreated SUD is associated with increased HIV risk behaviors, decreased use of and/or adherence to antiretroviral therapy, decreased viral suppression, and greater HIV-related symptoms.
Treatment of SUD can improve all these outcomes, and enhance overall health.
The NIDA Clinical Trials Network protocol CTN-0067, CHOICES, is evaluating the use of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression.
As they were recruiting subjects for the study, the team wanted to investigate barriers and facilitators to participation, which could inform both research and community treatment recruitment practices. Staff and medical providers from 6 participating HIV clinics completed in-depth, digitally recorded interviews in the fall of 2018.
The interviews looked at factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and strategies used by study staff that encourage eligible patient participation.
Barriers to recruitment included:
- Challenging patient social and structural factors (e.g., homelessness, living environments with high substance use, criminal legal system involvement)
- Difficulty locating patients with unsuppressed HIV viral load and OUD within the HIV clinic
- Time-consuming study enrollment processes
- Stigma around HIV and OUD which inhibited treatment seeking
- Distrust of research and researchers
- Fear of the opioid abstinence required prior to XR-NTX induction.
Facilitators of recruitment included:
- Trusted peer outreach/recruitment workers in the community
- Hospitalizations that offered windows of opportunities for screening and XR-NTX induction
- Providing transportation for participants
- Partnerships with harm reduction organizations for referrals.
Conclusions: Though study personnel encountered barriers to recruitment in the CHOICES study, people with untreated HIV and OUD can be enrolled in multisite clinical trials by using enhanced recruitment strategies that extend outside of the HIV clinic. Employing peer outreach workers and collaborating with syringe service programs may be especially helpful and merit inclusion in similar study protocols. Future studies may also want to consider broadening eligibility criteria to include individuals with unsuppressed HIV or targeting the varying drugs of choice in a specific community.
Citation: Hoffman KA, et al. Barriers and Facilitators to Recruitment and Enrollment of HIV-Infected Individuals with Opioid Use Disorder in a Clinical Trial. BMC Health Services Research 2019;19:862.