HIV has been a significant health challenge around the world since it first emerged in humans in the late 20th century. HIV, or human immunodeficiency virus, severely weakens a person’s immune system by depleting white blood cells responsible for fighting off infection. While with proper medical care, people with HIV can lead healthy lives, there is no cure or vaccine.
People who use drugs, including opioids, are at a higher risk of contracting HIV.
Michael Copenhaver, professor in the Department of Allied Health Sciences in the College of Agriculture, Health, and Natural Resources, has received two grants, totaling $4.7 million, from the National Institute on Drug Abuse to improve PrEP adherence and other HIV-risk-reduction behaviors among people who use drugs and mentor a group of early-career researchers. Copenhaver has been a principal investigator at UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP) for 20 years. He integrates his research into core graduate courses he teaches in allied health sciences.
The opioid epidemic is a pressing threat in the United States. Roughly 2.1 million Americans have an opioid use disorder (OUD), according to the National Center for Drug Abuse Statistics. Overdose deaths have steadily increased since the late 90s with opioid-related deaths being five times higher in 2019 than 1999.
At the same time, the number of HIV outbreaks among people who inject drugs has been increasing. As many people who begin abusing prescription opioids turn to injectables, their risk of contracting HIV from infected needles increases dramatically.
In the first grant, Copenhaver is conducting a trial to test a bio-behavioral, community-friendly health recovery program for people who use drugs.
Copenhaver’s approach will encourage PrEP adherence and engaging in HIV-risk-reducing behaviors. Copenhaver’s strategy integrates HIV prevention science with extant drug treatment programs and considers the role of cognitive dysfunction.
PrEP is an FDA-approved drug for preventing HIV contraction. Despite its proven effectiveness, PrEP has yet to be successfully scaled up, particularly among people who use drugs. One of the most significant problems is that individuals need to take PrEP every day. This can be a challenge for people who experience mild to moderate cognitive impairment. Many people who use drugs experience cognitive dysfunction as a result of chronic drug use, lifestyle experiences, and other health challenges.
Even the good interventions out there do not acknowledge or accommodate participants with cognitive dysfunction — Michael Copenhaver
Copenhaver’s recent work indicates that about 65% of high-risk people who use drugs and are on opioid replacement therapy had mild to moderate cognitive dysfunction and were thus less likely to fully process and utilize intervention content intended to help them reduce HIV risk.
“Even the good interventions out there do not acknowledge or accommodate participants with cognitive dysfunction,” Copenhaver says. “That’s really where our focus has been more recently — trying to find better ways to help everyone accrue the intended HIV prevention benefits.”
Copenhaver’s trial will evaluate the cost-effectiveness of this approach and its ability to be used in real-world treatment centers. Copenhaver will work with the APT Foundation, a treatment provider with locations in New Haven, West Haven, and North Haven.
Programs such as methadone maintenance programs, which have a high concentration of people who use drugs, are particularly important environments for these interventions. Methadone is an opioid replacement therapy used to treat opioid addiction.
Currently, prevention efforts have largely concentrated on either behavioral HIV risk reduction strategies or PrEP alone, rather than in combination. This has created only modest HIV risk reduction outcomes for this population.
If this trial proves efficacious and cost-effective, it could be rapidly disseminated and implemented as part of routine care in drug treatment programs, integrating HIV prevention and drug treatment services for a population that would benefit from both.
The methadone drug treatment program in which Copenhaver will be testing his intervention is a very common model. This means his findings could potentially be integrated into drug treatment programs all around the world.
Copenhaver’s second grant focuses on optimizing HIV prevention among opioid-dependent persons.
The researcher will work with individuals to reduce HIV risk behaviors and increase adherence and retention in drug treatment programs and PrEP.
While behaviors that can reduce an individual’s HIV risk are easily modifiable, to be successful, interventions need to carefully consider the specific needs of and challenges for the patient.
The patient-oriented approach will help reinforce PrEP adherence, OUD treatments, utilizing syringe services programs, as well as behavioral risk reduction.
Copenhaver will apply a patient-oriented research program for HIV prevention in clinical settings in high-priority areas domestically and abroad. He will work with collaborators in rural West Virginia and Ohio and internationally in Uganda, Malaysia, and Ukraine.
These areas are of particular interest because policies there often restrict people’s access to the full toolkit of medical and behavioral interventions for HIV prevention.
This K24 grant will support several new HIV-prevention investigators on the cusp of developing their own research programs. Copenhaver will mentor a group of approximately a dozen researchers through the Department of Allied Health Sciences’ doctoral program in health promotion science, InCHIP, and the Yale AIDS Program.
“The K24 will enable me to focus my efforts on training the next generation of intervention scientists,” Copenhaver says. “The department and InCHIP stimulate collaborations with a wealth of talented mentees who are equally passionate about HIV prevention and health promotion.”
Copenhaver holds a Ph.D. in psychology from Virginia Tech. He completed postdoctoral training at the Yale University School of Medicine. He is a licensed clinical psychologist. His work focuses on the implementation of evidence-based HIV prevention strategies.