An Evaluation a PrEP-Focused HIV Prevention Intervention Tailored for Individuals with Opioid Use Disorder and Cognitive Dysfunction

Colleen B Mistler; Tania B Huedo-Medina; Roman Shrestha; John Gunstad; Alexei Zelenev; Michael M Copenhaver

doi:10.2147/NDT.S490266

An Evaluation a PrEP-Focused HIV Prevention Intervention Tailored for Individuals with Opioid Use Disorder and Cognitive Dysfunction

Neuropsychiatr Dis Treat. 2025 Jun 24:21:1235-1248. doi: 10.2147/NDT.S490266. eCollection 2025.

Authors

Colleen B Mistler^#^{1

2}, Tania B Huedo-Medina^#^{2

3

4

5}, Roman Shrestha^{2

3}, John Gunstad⁶, Alexei Zelenev⁷, Michael M Copenhaver^{2

3}

Affiliations

¹ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
² Institute for Collaboration on Health, Intervention, and Policy (Inchip), University of Connecticut, Storrs, CT, USA.
³ Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
⁴ Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country UPV/EHU, Donostia-San Sebastián, Spain.
⁵ Basque Foundation for Science, IKERBasque, Bilbao, 48011, Spain.
⁶ Department of Psychological Sciences, Kent State University, Kent, OH, USA.
⁷ Department of Internal Medicine, AIDS Program, Yale School of Medicine, New Haven, CT, USA.

^# Contributed equally.

Abstract

Purpose: This study aimed to test the efficacy of the 4-week Bio-behavioral Community-Friendly Health Recovery Program (CHRP-BB) at improving HIV prevention outcomes among individuals receiving medication for opioid use disorder (MOUD) and to examine the extent to which cognitive dysfunction impacts outcomes.

Patients and methods: This randomized controlled trial included 237 individuals receiving MOUD and Pre-Exposure Prophylaxis (PrEP) in New Haven, CT. We conducted a longitudinal regression analysis to evaluate the impact of the intervention on HIV risk behaviors and PrEP-related outcomes over time. We estimated the effect of treatment on the outcome variables that include PrEP knowledge and adherence skills, HIV risk behavior, Syringe cleaning skills, and Condom skills using a difference-in-differences framework across four time periods (Post-intervention, and 3-, 6-, and 9-month follow-ups).

Results: The CHRP-BB intervention exerted a positive effect on experimental group participants across a range of key outcomes, particularly among shorter term IDUs. Improvements that were the most pronounced included PrEP outcomes (knowledge and adherence skills) and syringe cleaning skills. Most outcomes were not significantly disrupted by cognitive dysfunction.

Conclusion: Outcomes from this trial highlight the efficacy of the CHRP-BB intervention, including the use of cognitive dysfunction compensatory strategies, to significantly improve HIV prevention efforts among individuals on MOUD. We suggest that future efforts focus on refining and testing additional strategies that can further optimize intervention effects across a broader range of outcomes and MOUD patients.

Keywords: HIV prevention; cognitive dysfunction; medication for opioid use disorder; opioid use disorder; people who inject drugs; pre-exposure prophylaxis.

Publication types

Case Reports
Clinical Trial