Probation as a targeted entry point for scaling up opioid agonist therapies in Moldova using a modified screening, brief intervention and referral to treatment strategy

People with HIV and opioid use disorder (OUD) are concentrated in criminal legal settings. Consequently, decarceration efforts in Moldova have shifted many people in prisons to community supervision in probation. Probation differs from prisons as they have no mandate to screen and treat for medical conditions like OUD and link to evidence-based treatments like methadone or buprenorphine, otherwise known as medications for opioid use disorder (MOUD). We hypothesized that probation settings are a missed opportunity to screen and link to treatment for HIV and OUD. From November 2019 to April 2023, 900 consecutive entrants to 10 probation centers across Moldova underwent a modified screening, brief intervention, and referral to treatment (SBIRT) strategy to identify people on probation with OUD and link them to MOUD; testing for HIV, HCV, HBV, and syphilis was bundled for efficiency. Among those screening positive for OUD, interest in MOUD was assessed before and after the brief intervention. For those interested in MOUD, they were referred to treatment. MOUD interest was assessed using a single-item screening instrument, where higher scores were associated with greater interest in starting MOUD. Overall (N = 900), 15.1% (N = 136) participants met screening criteria for OUD, of which 119 (87.5%) were eligible for and enrolled in the brief intervention. Interest in MOUD after the brief intervention increased modestly, but significantly (p < 0.001). Overall, 33 (27.7%) of 119 participants initiated MOUD, and 32 (97%) of these were retained on treatment over 6-months. Predictors of initiating MOUD were perceiving MOUD to be an important treatment for OUD and having HCV and HIV. Twenty-seven (22.7%) tested positive for HIV, with 7 (25.9%) being newly diagnosed during the screening procedures. Rapid screening strategies can identify and provide opportunities for treatment for multiple interrelated chronic conditions. Implementation opportunities, however, will require aligning public safety mandates in probation with public health.