{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:13:22Z","timestamp":1783703602557,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA045556"],"award-info":[{"award-number":["R01DA045556"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["K24DA035684"],"award-info":[{"award-number":["K24DA035684"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and aims<\/jats:title><jats:p>People who inject drugs (PWID) are at risk for adverse outcomes across multiple dimensions. While evidence\u2010based interventions are available, services are often fragmented and difficult to access. We measured the effectiveness of an integrated care van (ICV) that offered services for PWID.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>This was a cluster\u2010randomized trial, which took place in Baltimore, MD, USA. Prior to randomization, we used a research van to recruit PWID cohorts from 12 Baltimore neighborhoods (sites), currently served by the city's mobile needle exchange program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention and comparator<\/jats:title><jats:p>We randomized sites to receive weekly visits from the ICV (<jats:italic>n<\/jats:italic>\u2009=\u20096) or to usual services (<jats:italic>n<\/jats:italic>\u2009=\u20096) for 14\u2009months. The ICV offered case management; buprenorphine\/naloxone; screening for HIV, hepatitis C virus and sexually transmitted infections; HIV pre\u2010exposure prophylaxis; and wound care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The primary outcome was a composite harm mitigation score that captured access to evidence\u2010based services, risk behaviors and adverse health events (range\u2009=\u20090\u221215, with higher numbers indicating worse status). We evaluated effectiveness by comparing changes in the composite score at 7\u00a0months versus baseline in the two study arms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>We enrolled 720 cohort participants across the study sites (60 per site) between June 2018 and August 2019: 38.3% women, 72.6% black and 85.1% urine drug test positive for fentanyl. Over a median of 10.4\u00a0months, the ICV provided services to 734 unique clients (who may or may not have been cohort participants) across the six intervention sites, including HIV\/hepatitis C virus testing in 577 (78.6%) and buprenorphine\/naloxone initiation in 540 (74%). However, only 52 (7.2%) of cohort participants received services on the ICV. The average composite score decreased at 7\u00a0months relative to baseline, with no significant difference in the change between ICV and usual services (difference in differences: \u22120.31; 95% confidence interval: \u22120.70, 0.08; <jats:italic>P<\/jats:italic>\u2009=\u20090.13).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This cluster\u2010randomized trial in Baltimore, MD, USA, found no evidence that weekly neighborhood visits from a mobile health van providing injection\u2010drug\u2010focused services improved access to services and outcomes among people who injected drugs in the neighborhood, relative to usual services. The van successfully served large numbers of clients but unexpectedly low use of the van by cohort participants limited the ability to detect meaningful differences.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16486","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T03:28:15Z","timestamp":1712028495000},"page":"1276-1288","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Integrated care van delivery of evidence\u2010based services for people who inject drugs: A cluster\u2010randomized trial"],"prefix":"10.1111","volume":"119","author":[{"given":"Kathleen R.","family":"Page","sequence":"first","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Weir","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore MD 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwaseun","family":"Falade\u2010Nwulia","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles","family":"Landry","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Escobar","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald E.","family":"Saxton","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan G.","family":"Sherman","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3013-4339","authenticated-orcid":false,"given":"Gregory M.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"2001\u20132021, NCHS data brief, no 457","author":"Spencer 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