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Peer-led harm reduction intervention for problem substance use in people who are homeless commissioning brief




The aim of the Health Technology Assessment (HTA) Programme is to ensure that high quality research information on the clinical effectiveness, cost-effectiveness and broader impact of healthcare treatments and tests are produced in the most efficient way for those who plan, provide or receive care from NHS and social care services. The commissioned workstream invites applications in response to calls for research on specific questions which have been identified and prioritised for their importance to the NHS, patients and social care.

Research question

What is the clinical and cost-effectiveness of a peer-led harm reduction intervention for problem substance use among people who are homeless?

  • Intervention: A peer-led harm reduction intervention. To be defined and justified by applicants.
  • Target group: People who are homeless or at risk of homelessness with problem substance use. Exact inclusion criteria to be defined and justified by applicants.
    Applications are encouraged which include recruitment from geographic populations with high disease burden which have been historically under-served by research activity in this field.
  • Setting: Settings which are regular points of contact for the target group in both primary and secondary care e.g. Outreach services, homeless shelters, homeless GP services.
  • Comparator: Standard care to be defined and justified by applicants. 
  • Study design: A randomised controlled trial with an internal pilot phase to test key trial processes such as recruitment and adherence. Clear stop/go criteria should be provided to inform progression from pilot to full trial. 
  • Important outcomes: Substance use. Quality of life. Social functioning.
  • Other outcomes: Risk taking behaviours, mental health, physical wellbeing, user acceptability, occupational (including voluntary roles)/educational outcomes, service engagement, service utilisation, therapeutic relationship, cost-effectiveness, social outcomes, peer worker outcomes.
    Where established Core Outcomes exist they should be included amongst the list of outcomes unless there is good reason to do otherwise.
  • Minimum duration of follow-up: One year.
  • Longer-term follow up: If appropriate, researchers should consider obtaining consent from participants to allow potential future follow up through efficient means (such as routine data) as part of a separately funded study.


People who are homeless are among the most disadvantaged and vulnerable in society. Homelessness includes not just those who are wholly without shelter but also those whose housing circumstances are insecure or inadequate.

People who are chronically homeless are liable to tri-morbidity, i.e. they are more likely to suffer from mental ill health, physical ill health and substance misuse. For many people who are homeless and have problem substance use, accessing mainstream drug and alcohol services can be challenging because their needs may not be generally well met due to inflexible service provision and a perception of negative staff attitudes towards them.

Frequently the goal of treatment services is abstinence, and this may be unrealistic for a person who is dealing with the burden of homelessness, illness and poverty. In recent times, there has been a growing emphasis on harm reduction strategies in services and organisations that work with people who are homeless and with problem substance use focusing on reducing the risk and harmful effects associated with problem substance use rather than abstinence. Harm reduction strategies used in the UK include overdose awareness training, the provision of take-home naloxone, peer support and needle exchange schemes.

In 2016 the HTA programme commissioned a study to evaluate the feasibility of a harm reduction intervention for people who are homeless. The study has now completed and has found that a peer-led harm reduction intervention is feasible and acceptable and that a randomised controlled trial is merited.

The importance of the question remains and the HTA programme now invites applications for a substantive trial to evaluate a peer-led harm reduction intervention for people who are homeless and with problem substance use. If you are applying to this call you may request a confidential pre-publication version of the report by contacting Applications should be informed by this study but need not be restricted to the intervention described if another can be justified.

Co-production, which ensures that the research demonstrates an equal partnership with service commissioners, providers and service users (or their advocates), should be embedded throughout the life cycle of the project from application to completion. Applicants may wish to consult the NIHR INVOLVE guidance on co-producing research.

Making an application

Please note that this call will open late-April. The advert on the funding opportunities page will be updated with the call opening date once confirmed and the link to the application form will be available once the call opens. Potential applicants are advised to check that advert for updates on the call open date.

Your application must be submitted on-line no later than 1pm on the 15 September 2021. Applications will be considered by the HTA Funding Committee at its meeting in November 2021.

Guidance notes and supporting information for HTA Programme applications are available by clicking the links.

Important: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in 2022

Applications received electronically after 1300 hours on the due date will not be considered.

For commissioned topics, the Programme strongly discourages the practice of the same co-applicant joining more than one competing team. There may be unusual circumstances where the same person could be included on more than on application eg a lead from a named charity or a unique national expert in a condition.

For such exceptions (i) each application needs to state the case as to why the same person is included (ii) the shared co-applicant should not divulge application details between teams and (iii) both teams should acknowledge in their application that they are aware that one of their co-applicants is part of a competing application and that study details have not been shared.

Should you have any queries please contact us: