Digital intervention delivered via street medicine to increase HIV and substance use care among survivors of sexual trafficking

Rhode Island Hospital has received a $764,165 Project Grant from the National Institute on Drug Abuse (NIDA) under the Drug Use and Addiction Research Programs (CFDA 93.279) to develop and evaluate the CONNECT program, a digital intervention designed to increase engagement in HIV and substance use disorder care among survivors of sex trafficking. The award, effective July 1, 2025 through June 30, 2028, supports the development of an evidence-based intervention that addresses critical health disparities affecting trafficking survivors, who experience disproportionately high rates of substance use, HIV/STI infections, and psychological trauma. The intervention will be delivered in collaboration with a street medicine team that provides direct health and social services to unhoused women in community settings, with support from trained care navigators who assist clients in completing the digital program and navigating referrals to specialized treatment services.

The project will employ a community-based participatory research approach informed by the Adaptation of Intervention Theory through Iterative Refinement (ADAPT-ITT) framework. Research activities include formative work with informant interviews, focus groups, stakeholder consultations, and community advisory board input to adapt the intervention. The evaluation plan comprises an open trial with 12 participants followed by a randomized pilot trial with 60 participants, both with two-month follow-up periods to assess program feasibility, acceptability, satisfaction, and preliminary efficacy in improving treatment outcomes for substance use, HIV/STI prevention and treatment, and mental health care engagement among trafficking survivors.

Abstract

SEX trafficking is a unique form of sexual violence and a growing concern. Substance use, HIV, STI, and psychological distress (e.g., ptsd, depression, anxiety) are common and interrelated morbidities among victims of SEX trafficking. Problematically, substance use treatment, HIV and STI treatment/prevention, and mental health treatment are under-utilized by trafficking victims potentially because of stigma, lack of knowledge, lack of trust in providers, and lack of access. Consistent with the goals of RFA-DA-25-018 engaging survivors of sexual violence and trafficking in HIV and substance use disorder services, the objective of this R34 application is to develop and evaluate the connect program for use in a sample of women with a history of SEX trafficking to evaluate its feasibility, acceptability, and preliminary efficacy. Connect will be delivered in collaboration with the street medicine team, which provides health and social services directly to unhoused women in their own environment; who are at high risk for SEX trafficking. Connect will also be administered with the support of a trained care navigator to provide 1:1 assistance in completing connect and navigating referrals to substance use, HIV/STI, and mental health care. Following adapt-ITT framework and informed by a community-based participatory research approach, information from informant interviews (N = 9), focus groups (N = 30), stakeholder interviews (N = 6), and the community advisory board will be leveraged to adapt the intervention. An open trial (N = 12) with a 2-month follow-up will be conducted to demonstrate program feasibility, acceptability, satisfaction, and utility of connect. A randomized pilot trial (N = 60) with a 2-month follow-up will be conducted to examine whether women randomized to connect, relative to control, show change in: treatment engagement outcomes for substance use (e.g., moud initiation, therapy for alcohol use), HIV and STI treatment/prevention services (e.g., uptake of prep, testing for STI), and/or mental health treatment (e.g., treatment for ptsd). Secondary outcomes of domains relating to motivation to seek treatment aligned with the theory of planned behavior (i.e., attitudes, intentions, self-efficacy, subjective norms, and stigma will be explored. Behavioral outcomes of changes in substance use outcomes (e.g., reduced substance use), HIV and STI risk behaviors, and mental health outcomes (e.g., improvements in ptsd) will also be examined. Mediators (i.e., readiness to change) and moderators (i.e., trauma history) will be examined (EXPLORATORY). To prepare for hybrid type II efficacy trial, exit interviews will be conducted with participants (N = 20), and practitioners (N = 9) to describe contextual factors that might influence subsequent implementation. This research is expected to produce a scalable strategy to promote treatment engagement for multiple interrelated harms among women with experiences of SEX trafficking, with the goal of promoting multiple domains of wellbeing.