Date of Completion


Embargo Period



People who use drug, HIV prevention, combination approach, pre-exposure prophylaxis, mHealth, neurocognitive impairment, substance abuse, methadone maintenance treatment

Major Advisor

Michael M. Copenhaver

Associate Advisor

Thomas F. Babor

Associate Advisor

Valerie B. Duffy

Field of Study

Public Health


Doctor of Philosophy

Open Access

Campus Access


Introduction: To date, HIV prevention efforts have largely relied on singular strategies (e.g., behavioral or bio-medical approach alone) with modest HIV risk reduction outcomes for people who use drugs (PWUD). Therefore, this study aimed to develop and test an integrated approach to prevent HIV that incorporates innovative behavioral strategies to address the population’s specific risk reduction and cognitive needs to improve existing HIV prevention efforts.

Methods: We conducted a series of formative studies to develop an integrated bio-behavioral HIV prevention approach and pilot tested the integrated bio-behavioral approach for feasibility, acceptability, and preliminary efficacy among high-risk PWUD in treatment.

Results: We used a data-driven approach to develop the combination HIV prevention approach by integrating PrEP into the evidence-based Community-friendly Health Recovery Program (CHRP) – a brief primary HIV prevention behavioral intervention for high risk PWUD based on the Information-Motivation-Behavioral Skills (IMB) model of behavioral change. This combination approach – now called CHRP-BB – also incorporated innovative strategies (e.g., mHealth technology, cognitive remediation tools) to enhance PrEP adherence and HIV risk reduction while effectively accommodating those with neurocognitive impairment (NCI). Moreover, the findings provided strong evidence of feasibility and acceptability, and preliminary evidence of efficacy of the new CHRP-BB approach to optimally address PrEP adherence and HIV risk reduction needs of high risk PWUD in the context of a common drug treatment setting.

Conclusion: The resultant integrated, brief bio-behavioral approach could significantly advance primary HIV prevention science by optimizing PrEP adherence and HIV risk reduction among high risk PWUD within treatment settings.