Project dates: October 2025 - August 2026
People who use drugs (PWUD) face disproportionately high sexually transmitted infections (STIs) due to intersecting behavioral, social, and structural risks, yet most studies examine these factors in isolation. Understanding how multi-level influences converge is critical to designing scalable, equity-focused prevention strategies.
This pilot project will integrate national survey data with a local intervention trial to advance knowledge of disparities, phenotypes, and place-based drivers of STI risk among PWUD. Using National Survey on Drug Use and Health (NSDUH) data, the study will quantify disparities across socioeconomic and demographic gradients, identify multi-level “risk phenotypes” through latent class analysis, and generate small-area estimates of geographic variation. It will then test the feasibility and transportability of these findings in the Community Wise optimization trial of formerly incarcerated men with substance use disorder. Analyses will validate whether NSDUH-derived phenotypes replicate in this high-risk cohort and examine heterogeneous treatment effects to determine which subgroups benefit most from intervention participation. Finally, it will synthesize findings to develop an environmentally grounded conceptual framework linking individual, relational, and community-level factors to STI outcomes among PWUD.
The results will help to inform scalable approaches to reduce STI and HIV disparities among PWUD.