Meeting People Where They Are for HPTN 094
Jessica Yeager starts each morning by reading her Bible, recovery books, and meditating. Then, she posts all over social media about the HPTN 094 mobile health unit and its location for the day. According to her peers, Yeager is an influential recovery community leader who thrives on innovative change to create purpose, stomp out stigma, and help others heal while delivering the message of hope. Yeager is a peer support services supervisor at the University of Texas Health Science Center in Houston. She is also a national and Texas-state-certified peer recovery support specialist. Her job is demanding, requiring her to spend her workdays helping others in the recovery health process to reduce their likelihood of relapsing.
Yeager has a unique perspective regarding substance misuse as she is a person in long-term recovery. "I'm very vocal about my recovery journey," said Yeager. "I am proud to recover out loud, and what that means to me is that I've not found it necessary to change how I feel with any mind-altering substances since January 29, 2016."
Yeager is one of many healthcare professionals supporting HPTN 094 or ‘INTEGRA.’ The vanguard study was developed to determine the efficacy of using a mobile health unit to provide integrated health services – particularly medication for opioid use disorder (OUD) and medicines for HIV treatment or prevention – to people with OUD who inject drugs in five U.S. cities (Houston, Los Angeles, New York, Philadelphia, and Washington, D.C.).
Launched May 2021, HPTN 094 will enroll 450 people 18-60 years of age living with OUD, injecting drugs, and at risk of acquiring or living with HIV. Participants are randomized to either an intervention arm or an active control arm. In the first 26 weeks, intervention arm participants receive “one-stop” health services in a mobile health unit and peer navigation from a peer recovery coach. During this time, mobile units provide intervention arm participants with primary care services, including medications for OUD, antiretroviral therapy, pre-exposure prophylaxis, and treatment for sexually transmitted infections. Harm reduction services, screening, and referral for hepatitis, mental health issues, and other medical conditions are also offered. By 26 weeks, intervention arm participants will transition to health services available in the community. Active control arm participants receive peer navigation to health services available in the community during the first 26 weeks.
People who inject drugs (PWID) face more than just the risk of overdose. The lack of access to health care (including medication for opioid use disorder), poverty, prevalent poly-substance use, and mental health disorders experienced by PWID combine to exacerbate the risk of HIV transmission and acquisition and other health issues.
“There are many layers of stigma among those who inject, use opiates, are sex workers, or have multiple partners," said Yeager. "Being present in the community helps us knock down these stigma layers. We help without judgment and at no cost to the individual."
At UTHealth, Yeager and her colleagues help individuals who inject substances and struggle with opiate addiction or struggle to manage their addiction. "I'm very passionate about people struggling because I was one of those people, and I had no idea where to go or what resources were out there," said Yeager. "I think the power of the peer is huge." According to Yeager, if detox or treatment centers have long wait times, the clinical research site can be a starting point for individuals to access extended services and support services until they can get into a program of action. "We are a starting point in the resource center to get someone out of active use (use?) and into an immediate solution," said Yeager.
Research studies face many challenges when recruiting participants, and HPTN 094 is no different. According to Yeager, the biggest challenge is that many participants do not have a phone, so that follow-ups can be difficult. "We're pretty awesome with our 26 and 52-week follow-ups," said Yeager. "The ones we have not been able to reach are incarcerated, and we stay on top of that and try to stay in communication so that upon release, we can get their follow-up."
Another challenge is that some people are resistant to getting help from others. "We seem to have less resistance from potential study participants when we use the terms 'services' or 'programs' versus 'study,'" said Yeager. "People who inject drugs do not want to be viewed as addicts or criminals or convicts; they are human beings that suffer an illness," Yeager said. "And they can be successful when provided the correct services and treatment."
Yeager started as a peer support specialist early on and has mentored and trained many who have followed her pathway. Her career has transformed into training and creating influential peer specialists to continue the work. She is currently in college, working towards a degree in social work. "I would love to one day run a foundation or a business of my own where it's much bigger, where there are lots of peer services, there are lots of avenues to help individuals, boots on the ground," said Yeager. "I'm very passionate about people struggling because I was one of those people, and I had no idea where to go or what resources were out there. I think the power of the peer is huge."
According to Yeager, the greatest satisfaction is watching miracles happen. "Watching somebody truly start believing in themselves again and gaining momentum to be successful in their pathway is beautiful."
As for HPTN 094, the study continues to enroll participants, with primary results anticipated in early 2026.
For more information about UTHealth-Houston, visit https://med.uth.edu/internalmedicine/hptn-094-integra/integra-staff/
For more information about HPTN 094, visit https://www.hptn.org/research/studies/hptn094.