WINGS +++ An effectiveness trial of syndemic mhealth intervention to increase MOUD uptake among women Impacted by Intimate partner Violence and PTSD

About This Grant

Women with opioid use disorder (OUD) and substance use disorders (SUDs) have high rates of intimate partner violence (IPV). \. IPV victimization and IPV-related post-traumatic stress disorder (PTSD) have been found to increase the likelihood of experiencing a drug overdose, OUD/SUDs, and poor drug treatment outcomes. However, there remains a lack of evidence-based interventions that identify IPV and PTSD symptoms among women with OUD/SUDs and link them to appropriate services. To address this critical gap, this R61/R33 study will pilot-test and conduct a hybrid type 1 effectiveness implementation trial of a brief mHealth intervention entitled Women Initiating New Goals of Safety (WINGS+++). WINGS+++ is an integrated 3-session screening, brief intervention, and referral resource tool (SBIRT) that includes an evidence-based IPV SBIRT tool developed by the investigative team, which will be combined with a novel PTSD SBIRT tool that will identify IPV-related PTSD and a widely used OUD/SUD screening tool and service coordination platform. WINGS+++ will also include evidence-based peer navigation, which will provide enhanced linkage to services that may best synergistically address IPV, PTSD, and OUD/SUD, according to the screening results and preferences of women. This study will be conducted in Orange County in New York (NYS), a site of our NIDA-funded HEALing Communities Study (HCS) in collaboration with our HCS overdose prevention coalition. Orange County has a very high rate of fatal opioid overdose that is surging among residents. For the two-year R61 phase, we will pilot test the feasibility, acceptability, and safety of WINGS+++ with 30 women with OUD/SUD who have experienced IPV in the past year in a single-arm pre-post trial. For the four-year R33 phase, we will test the effectiveness of WINGS+++ vs. standard-of-care SUD SBIRT control condition with 400 women on reducing non-prescription opioid and other drug use (primary outcome), measured by biological assay and self-report. Secondary outcomes include IPV, PTSD symptoms, and linkage to SUD treatment and IPV and other services. This study will be conducted in risk mitigation, health and wellness support service programs and a broad range of community sites in Orange County. We will employ a robust, community- engaged, data-driven approach using group model building and a real-time dashboard that will enable the coalition and study team to track recruitment, enrollment, attendance, retention, and service referral linkages. The study will be guided by the PRISM/RE-AIM(S) implementation science framework that will employ mixed methods to examine multilevel contextual factors that influence the intervention’s reach, effectiveness, adoption, implementation, maintenance, and sustainability. Cost analyses will examine the economic impact and cost-effectiveness. If effective, WINGS+++ may be implemented in risk mitigation, health and wellness support service programs and other community settings to address the OUD/SUD and IPV syndemic.