The reach, effectiveness, implementation, and maintenance of a New York City harm reduction program enrolling...

Methamphetamine use is associated with risk of HIV transmission and poor HIV outcomes. In 2016, the NYC Health Department created a harm reduction program for methamphetamine users. Utilizing an implementation science framework (RE-AIM), we descriptively evaluated the program's reach, effectiveness, implementation, and maintenance of participant outcomes.

Participants included in this descriptive evaluation reported methamphetamine use in the past year, completed an assessment at enrollment, and received at least one service from January 2017-June 2022. Programmatic and surveillance data were used to measure outcomes related to populations engaged (reach), service use (implementation), methamphetamine use (effectiveness/maintenance), engagement in HIV care (effectiveness/maintenance), viral suppression (effectiveness), seroconversions (effectiveness), and PrEP use (effectiveness/maintenance).

The program enrolled more people with HIV (53.6%) than people without HIV (PWoH) (46.4%), totaling 545 participants. More White men who have sex with men (MSM) enrolled (34.2%), than Latino (30.5%) and Black MSM (23.6%). The most common services delivered were substance use counseling, health education, and benefits navigation. Before the program concluded, 6.7% (17/253) of PWoH seroconverted. The proportions seroconverting were higher among Black MSM (15.0%) and Latino MSM (7.4%), and lower among White MSM (3.0%). Among those reassessed (165/545), 44.0% continued to use methamphetamine as of their first reassessment.

At reassessment, less than half reported recent methamphetamine use. Seroconversions occurred mostly among MSM of color, suggesting that greater engagement and support are needed for priority populations. Findings align with prior research showing frequent HIV seroconversion and a high need for non-medical services among MSM using methamphetamine.