Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network’s CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals’ experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.

Problem: The practice of evidence-based medicine relies on clinical research to develop innovations in treatment and prevention. Clinical research professionals (CRPs) are critical to the development of safe and effective health interventions that guide medical practice, yet several challenges threaten the stability of the clinical research workforce. A lack of clear career pathways, inconsistent training standards, and underrepresentation of diverse populations in the workforce inhibit growth of the profession, contribute to high turnover and staffing shortages, and impact the ability to conduct research at clinical sites and academic medical centers. Without structured pathways to attract and guide new professionals to the field, the demand for trained CRPs to conduct the increasing number of clinical trials supporting academic medicine will remain unmet. Approach: Duke University partnered with academic clinical research programs at Durham Technical Community College and North Carolina Central University to establish experiential learning pathways facilitating entry into the clinical research workforce. Between January 2021 and May 2024, clinical research students completed a training program, including intake and matching, onboarding, preceptor preparation and goal setting, an internship period, and evaluation. Outcomes: Forty-seven students completed learning experiences under this partnership model. Of these, 14 (29.8%) secured employment in clinical research, including 8 at Duke, 2 at another academic medical center, and 4 in private industry. Structured experiential learning in clinical research confirmed that experiential learning complemented academic training and improved understanding of clinical research roles. In addition, centralized onboarding, initial training, and professional development workshops provide clear guidelines for interns and mentors across all learning pathways. Next Steps: Duke is working to expand the network of clinical research preceptors and mentors within this partnership model. Duke will engage research managers to showcase the benefits of hosting clinical research students and highlight streamlined administrative processes.