Community-based health navigation to reduce drug-related harms in rural settings: A pooled analysis of two intervention trials

People who use drugs in rural communities face barriers to accessing services that reduce overdose and infectious disease risk. Community-based navigation may help bridge these gaps, but limited evidence exists to support its effectiveness in real-world rural settings. This study aimed to estimate the effect of two adapted prevention navigation interventions on substance use outcomes among people who use drugs from rural communities.

We conducted a pooled analysis of two pragmatic trials using harmonized measures, one cluster-randomized trial and one quasi-experimental trial. Participants were adults who use opioids and/or stimulants, recruited through syringe service programs, jails, or pretrial service agencies. The intervention was an adaptation of Project START, delivered by trained prevention navigators; the comparator was usual care, consisting of standard harm reduction and referral services. The primary outcome was change in past 30-day opioid use between baseline and three-month follow-up. Secondary outcomes included days of stimulant use and self-identified drug of choice. Regression models were adjusted for age, gender, and race/ethnicity.

Among 289 individuals with complete outcome data, intervention participants reported a greater reduction in opioid use compared with controls (pooled mean difference: -2.98 days; 95% CI: -5.53, -0.42). Changes in stimulant use and use of drug of choice were not statistically significant but trended in the same direction.

An adapted community-based prevention navigation intervention delivered by trained navigators was associated with a modest but significant reduction in past 30-day opioid use among people who use drugs in rural communities, compared with usual care.