{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:10:25Z","timestamp":1756167025371,"version":"3.44.0"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life with HIV and Substance Use (ePORTAL HIV-S) is a research project funded by the National Institute for Drug Abuse to implement and evaluate multi-level interventions to decrease barriers to substance use screening and treatment for PLWH. At its center is a multidomain intervention addressing digital, sociocultural, and health care system environments, at individual, interpersonal, and community levels. ePORTAL HIV-S has four overall goals; this manuscript describes the protocol specifically for the randomized control trial (RCT) portion of the study. To provide additional context, we briefly describe the overall ePORTAL HIV-S project.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This project will utilize a culturally tailored approach to increase patient portal use among PLWH in our health system via a community health worker (CHW)-led initiative. This will lay the groundwork for the second aim, the focus of the current manuscript, RCT to measure the effectiveness of a population health, patient portal-based substance use screening program. Approximately 880 people will be enrolled and randomized 1:1 to intervention vs., control arms. Participants in the control arm will receive usual care (substance use screening during clinic visits), whereas the intervention arm will be invited to complete substance use screening via the patient portal as well as during clinic visits as per usual care. The primary outcome will be the percentage of people screened for substance use. ePORTAL will also implement a collaborative care model to both connect patients who screen positive for SUD to care and effectively treat PLWH. Finally, we will plan for dissemination of ePORTAL HIV-S to other sites that provide care for PLWH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>SUD disproportionately impacts PLWH which leads to negative health outcomes. This novel approach will incorporate the privacy and convenience of patient portal screening with screening during routine clinic visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:uri>clinicaltrials.gov<\/jats:uri>, identifier NCT06682468.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1583546","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T16:15:23Z","timestamp":1756138523000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Protocol for a randomized controlled trial of patient\u2013portal\u2013based screening for substance use among people with HIV"],"prefix":"10.3389","volume":"13","author":[{"given":"Eric","family":"Roessler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Zimmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Grant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harold","family":"Pollack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basmattee","family":"Boodram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleanor","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jade","family":"Pagkas-Bather","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell A.","family":"Brewer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Ridgway","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neda","family":"Laiteerapong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1136\/sextrans-2021-055199","article-title":"Risk factors for HIV infection among men who have sex with men in the ANRS IPERGAY PrEP trial","volume":"98","author":"Gras","year":"2022","journal-title":"Sex Transm Infect"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1080\/09540121.2018.1445827","article-title":"HIV-related stigma and optimism as predictors of anxiety and depression among HIV-positive men who have sex with men in the United Kingdom and Ireland","volume":"30","author":"Murphy","year":"2018","journal-title":"AIDS Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1080\/08870446.2019.1572143","article-title":"Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use","volume":"34","author":"Crockett","year":"2019","journal-title":"Psychol Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13011-019-0240-3","article-title":"The prevalence of alcohol use disorders among people living with HIV\/AIDS: a systematic review and meta-analysis","volume":"14","author":"Duko","year":"2019","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1089\/apc.2010.0139","article-title":"Mortality after diagnosis of psychiatric disorders and co-occurring substance use disorders among HIV-infected patients","volume":"24","author":"DeLorenze","year":"2010","journal-title":"AIDS Patient Care STDs"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1007\/s11606-020-06389-7","article-title":"Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV","volume":"36","author":"Tsui","year":"2021","journal-title":"J Gen Intern Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.1007\/s10461-021-03157-4","article-title":"Association of Substance use Disorders with engagement in care and mortality among a clinical cohort of people with HIV in Washington, DC","volume":"25","author":"Doshi","year":"2021","journal-title":"AIDS Behav"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1007\/s10461-016-1584-6","article-title":"Prevalence and predictors of substance use disorders among HIV care enrollees in the United States","volume":"21","author":"Hartzler","year":"2017","journal-title":"AIDS Behav"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1001\/archpsyc.1988.01800330091011","article-title":"Prevalence of psychiatric disorders among men infected with human immunodeficiency virus: a controlled study","volume":"45","author":"Atkinson","year":"1988","journal-title":"Arch Gen Psychiatry"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.1016\/S0895-4356(01)00443-7","article-title":"General medical and psychiatric comorbidity among HIV-infected veterans in the post-HAART era","volume":"54","author":"Kilbourne","year":"2001","journal-title":"J Clin Epidemiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1001\/archpsyc.58.8.721","article-title":"Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States","volume":"58","author":"Bing","year":"2001","journal-title":"Arch Gen Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1089\/088922204773004860","article-title":"Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire","volume":"20","author":"Samet","year":"2004","journal-title":"AIDS Res Hum Retrovir"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1097\/01.qai.0000219773.82055.aa","article-title":"Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the southeastern United States","volume":"42","author":"Pence","year":"2006","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref14","article-title":"Racial\/ethnic differences in substance use, substance use disorders, and substance use treatment utilization among people aged 12 or older (2015-2019)","year":"2021"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1007\/s10461-020-02982-3","article-title":"Substance use stigma, avoidance coping, and missed HIV appointments among MSM who use substances","volume":"25","author":"Batchelder","year":"2021","journal-title":"AIDS Behav"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"108423","DOI":"10.1016\/j.jsat.2021.108423","article-title":"Utilization of substance use treatment among criminal justice-involved individuals in the United States","volume":"125","author":"Rowell-Cunsolo","year":"2021","journal-title":"J Subst Abus Treat"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0237772","DOI":"10.1371\/journal.pone.0237772","article-title":"Substance use service availability in HIV treatment programs: data from the global IeDEA consortium, 2014-2015 and 2017","volume":"15","author":"Parcesepe","year":"2020","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.jsat.2007.11.005","article-title":"Substance abuse treatment in human immunodeficiency virus: the role of patient-provider discussions","volume":"35","author":"Korthuis","year":"2008","journal-title":"J Subst Abus Treat"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1016\/j.drugalcdep.2017.06.009","article-title":"Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample","volume":"178","author":"Krawczyk","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1001\/jamapsychiatry.2013.3575","article-title":"Race\/ethnicity and geographic access to Medicaid substance use disorder treatment facilities in the United States","volume":"71","author":"Cummings","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"105833","DOI":"10.1016\/j.cct.2019.105833","article-title":"Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: protocol for the promoting access to care engagement (PACE) trial","volume":"84","author":"Satre","year":"2019","journal-title":"Contemp Clin Trials"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.5897\/JAHR11.046","article-title":"Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults","volume":"4","author":"Fredericksen","year":"2012","journal-title":"J AIDS HIV Research"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1177\/0956462419890727","article-title":"The individual, interactive, and syndemic effect of substance use, depression, education, and ethnicity on retention in HIV care","volume":"32","author":"Myers","year":"2021","journal-title":"Int J STD AIDS"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2815","DOI":"10.1007\/s10461-021-03172-5","article-title":"HIV and substance use stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in Russia","volume":"25","author":"Vetrova","year":"2021","journal-title":"AIDS Behavior"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1097\/QAI.0b013e31827f578a","article-title":"Retention among north American HIV-infected persons in clinical care, 2000-2008","volume":"62","author":"Rebeiro","year":"2013","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1089\/apc.2019.0067","article-title":"Engagement and retention in HIV Care for Transgender Women: perspectives of medical and social service providers in new York City","volume":"34","author":"Bockting","year":"2020","journal-title":"AIDS Patient Care STDs"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1007\/s10461-017-1716-7","article-title":"Daily marijuana use is associated with missed clinic appointments among HIV-infected persons engaged in HIV care","volume":"21","author":"Kipp","year":"2017","journal-title":"AIDS Behav"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.drugalcdep.2016.09.015","article-title":"Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients","volume":"168","author":"McGinnis","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1007\/s11606-015-3248-z","article-title":"Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study","volume":"30","author":"Williams","year":"2015","journal-title":"J Gen Intern Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"113824","DOI":"10.1016\/j.socscimed.2021.113824","article-title":"Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances","volume":"275","author":"Batchelder","year":"2021","journal-title":"Soc Sci Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1177\/1359105313507964","article-title":"Intersectionality of internalized HIV stigma and internalized substance use stigma: implications for depressive symptoms","volume":"20","author":"Earnshaw","year":"2015","journal-title":"J Health Psychol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1197\/jamia.M2835","article-title":"Initial experience with patient-clinician secure messaging at a VA medical center","volume":"16","author":"Byrne","year":"2009","journal-title":"J Am Med Inform Assoc"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e68091","DOI":"10.2196\/68091","article-title":"Sociodemographic and socioeconomic determinants for the usage of digital patient portals in hospitals: systematic review and Meta-analysis on the digital divide","volume":"27","author":"Goldberg","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.hlpt.2017.11.003","article-title":"Patient access to electronic health records: differences across ten countries","volume":"7","author":"Ess\u00e9n","year":"2018","journal-title":"Health Policy Technology"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12911-020-1047-x","article-title":"Users' acceptance of electronic patient portals in Lebanon","volume":"20","author":"Honein-AbouHaidar","year":"2020","journal-title":"BMC Med Inform Decis Mak"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e0285226","DOI":"10.1371\/journal.pone.0285226","article-title":"Digital health in fragile states in the Middle East and North Africa (MENA) region: a scoping review of the literature","volume":"18","author":"El-Jardali","year":"2023","journal-title":"PLoS One"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"S123","DOI":"10.7326\/M19-0876","article-title":"Using electronic health record portals to improve patient engagement: research priorities and best practices","volume":"172","author":"Lyles","year":"2020","journal-title":"Ann Intern Med"},{"key":"ref38","volume-title":"MGMA Stat: Most practices offer a patient portal","year":"2018"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"134","DOI":"10.3390\/jpm11020134","article-title":"Acceptability of a patient portal (opal) in HIV clinical care: a feasibility study","volume":"11","author":"Chu","year":"2021","journal-title":"J Personalized Medicine"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e14739","DOI":"10.2196\/14739","article-title":"mHealth interventions to promote anti-retroviral adherence in HIV: narrative review","volume":"8","author":"Lee","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.2196\/resprot.2302","article-title":"Barriers and facilitators of online patient portals to personal health records among persons living with HIV: formative research","volume":"2","author":"Luque","year":"2013","journal-title":"JMIR Research Protocols"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.drugalcdep.2016.01.007","article-title":"Interviewer-administered TLFB vs. self-administered computerized (A-CASI) drug use frequency questions: a comparison in HIV-infected drug users","volume":"161","author":"Delker","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1007\/s11606-022-07779-9","article-title":"Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-depression study","volume":"38","author":"Franco","year":"2023","journal-title":"J Gen Intern Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e48935","DOI":"10.2196\/48935","article-title":"Population-level portal-based anxiety and depression screening perspectives in HIV care clinicians: qualitative study using the consolidated framework for implementation research","volume":"8","author":"Zimmer","year":"2024","journal-title":"JMIR Formative Research"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"692","DOI":"10.3390\/ijerph21060692","article-title":"Patient perspectives on portal-based anxiety and depression screening in HIV care: a qualitative study using the consolidated framework for implementation research","volume":"21","author":"Walker","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e71","DOI":"10.2196\/jmir.1603","article-title":"Factors influencing the use of a web-based application for supporting the self-care of patients with type 2 diabetes: a longitudinal study","volume":"13","author":"Nijland","year":"2011","journal-title":"J Med Internet Res"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s12911-018-0669-8","article-title":"On the effect of electronic patient portal on primary care utilization and appointment adherence","volume":"18","author":"Zhong","year":"2018","journal-title":"BMC Med Inform Decis Mak"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"S52","DOI":"10.1097\/MLR.0b013e31827808db","article-title":"Evaluating patient access to electronic health records: results from a survey of veterans","volume":"51","author":"Nazi","year":"2013","journal-title":"Med Care"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.acap.2013.02.002","article-title":"Correlates of patient portal enrollment and activation in primary care pediatrics","volume":"13","author":"Ketterer","year":"2013","journal-title":"Acad Pediatr"},{"key":"ref50","first-page":"eSP7","article-title":"Older adult consumers' attitudes and preferences on electronic patient-physician messaging","volume":"19","author":"Lam","year":"2013","journal-title":"Am J Manag Care"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e0217636","DOI":"10.1371\/journal.pone.0217636","article-title":"Patients with complex chronic conditions: health care use and clinical events associated with access to a patient portal","volume":"14","author":"Reed","year":"2019","journal-title":"PLoS One"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/1062860614523488","article-title":"Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center","volume":"30","author":"Neuner","year":"2015","journal-title":"Am J Med Qual"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"3091","DOI":"10.1007\/s10461-012-0399-3","article-title":"Personal health record use and its association with antiretroviral adherence: survey and medical record data from 1871 US veterans infected with HIV","volume":"17","author":"Keith McInnes","year":"2013","journal-title":"AIDS Behav"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e081477","DOI":"10.1136\/bmj-2024-081477","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"Chan","year":"2025","journal-title":"BMJ"},{"key":"ref55","year":"2018"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooae094","article-title":"Implementation of an EHR-integrated web-based depression assessment in primary care: PORTAL-depression","volume":"7","author":"Franco","year":"2024","journal-title":"JAMIA Open"},{"key":"ref57","volume-title":"Statistical issues in drug research and development","author":"Fisher","year":"1990"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.jaac.2010.10.005","article-title":"Disparities in treatment for substance use disorders and co-occurring disorders for ethnic\/racial minority youth","volume":"50","author":"Alegria","year":"2011","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"2501","DOI":"10.1007\/s10461-021-03212-0","article-title":"African American\/black and Latino adults with detectable HIV viral load evidence substantial risk for polysubstance substance use and co-occurring problems: a latent class analysis","volume":"25","author":"Cleland","year":"2021","journal-title":"AIDS Behav"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1583546\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T16:15:24Z","timestamp":1756138524000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1583546\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":59,"alternative-id":["10.3389\/fpubh.2025.1583546"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1583546","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]},"article-number":"1583546"}}