Ending HIV: Bringing Integrated Prevention and Treatment Services to People Who Use Drugs Where They Live

项目摘要： 美国(美国)结束艾滋病毒流行(EHE)计划的主要目标是减少新的 到2030年艾滋病毒感染率达到90%，但这不会发生，除非我们找到方法将证据- 为吸毒者提供的基础服务(PWUD)。在美国，服药过量死亡人数急剧增加， 而芬太尼和兴奋剂正在助长新的艾滋病毒流行。我的事业和我的激情都围绕着 阿片类药物使用障碍(OUD)和其他物质使用障碍的治疗与艾滋病毒治疗的结合 和预防。通过20多年的直接临床护理，作为传染病和成瘾药物 医生结合了大量涉及PWUD与艾滋病毒携带者和风险的临床研究专业知识，我 知道EHE计划中的盲点，我可以用这个先锋奖来填补它们。我的创业奖 愿景是：1)将生活在受高剂量过量影响的社区的人培养成社区 卫生工作者(CHW)提供艾滋病毒检测和OUD快速诊断；2)创建移动枢纽， 轮子上的药房和诊所，可以被部署来立即分发暴露前预防措施 (PREP)、抗逆转录病毒治疗(ART)和药物治疗(Moud)；3)发展迅速 由社区卫生工作者和药剂师组成的可部署的移动快速反应小组(移动辐条)，有24人 从移动中心部署到CHW确定的位置的在线临床医生 药物(PrEP/ART基于快速艾滋病毒检测结果，Moud适用于诊断为 和4)与研究人员(包括建模人员)合作，确定优先考虑的位置 艾滋病毒最有可能爆发，并为从事艾滋病毒领域工作的其他人提供了一个合作中心 和物质使用障碍，以帮助为这一拟议的护理模式提供信息。通过这个奖项，我还将确保 移动快速反应小组继续跟踪人们并帮助他们保持药物和 解决相互竞争的需求，消除获取服务的障碍。因此，这位先驱者的总体想法 根据EHE计划，我们将在多个接入点提供低门槛服务 将检测和治疗计划(Moud、PrEP/ART)带到PWUD，并通过非 在他们生活的地方使用传统的方法。通过使用社区(CHW)中受过培训的人员 他们的社区成员有共同的生活经历，他们使用毒品，处于危险之中或感染了艾滋病毒， 我们可以提供与药剂师相结合的检测和诊断服务，以便在 向通常无法访问我们的正常临床或研究场所的人提供实时服务，包括 妇女、涉及司法的人、移民、没有保险的人和代表不足的少数群体。我有 经验、激情、职业道德和协作团队，通过这一点帮助结束PWUD的艾滋病毒 先锋奖。

Project Abstract: The United States (U.S.) Ending the HIV Epidemic (EHE) plan’s primary goal is to reduce the number of new HIV infections by 90% by 2030, but this will not happen unless we develop ways to BRING the evidenced- based services to persons who use drugs (PWUD). Overdose deaths are dramatically increasing in the US, and fentanyl and stimulants are fueling new HIV epidemics. My career and my passion revolve around integration of treatment of opioid use disorder (OUD) and other substance use disorders with HIV treatment and prevention. Through over 20 years of direct clinical care as an infectious disease and addiction medicine physician combined with substantial clinical research expertise involving PWUD living with and at risk of HIV, I know the blind spots in the EHE plan and I can fill them in with this pioneer award. My pioneering award vision is to: 1) train persons who live in the communities affected by high levels of overdose to be community health workers (CHWs) to provide the HIV testing and rapid diagnosis of OUD; 2) create mobile hubs that are pharmacies and clinics on wheels that can be deployed to immediately dispense pre-exposure prophylaxis (PrEP), antiretroviral therapy (ART), and medication treatment for OUD (MOUD) anywhere; 3) develop rapidly deployable mobile rapid response teams (the mobile spokes) comprised of the CHWs and pharmacists with 24 hour access to online clinicians that deploy out from the mobile hubs to where the CHWs identify to bring the medications (PrEP/ART based on the rapid HIV testing results, and MOUD to people who have a diagnosis of OUD) to where people ‘live’; and 4) collaborate with researchers, including modelers, to prioritize where outbreaks of HIV are most likely to occur and provide a collaboration hub for others working in the fields of HIV and substance use disorders to help inform this proposed care model. Through this award, I will also ensure that the mobile rapid response teams continue to follow people and help them retain on the medications and address competing needs to eliminate barriers to accessing services. Thus, the overall idea in this pioneer award is providing low barrier services at multiple access points in line with the EHE plans where we would be BRINGING the testing and treatment plans (MOUD, PrEP/ART) to PWUD and RETAINING them via non- traditional methods where THEY LIVE. Through using trained persons who LIVE in the communities (CHWs) with shared living experiences of their community members who use drugs and are at risk or living with HIV, we can provide the testing and diagnosis services combined with pharmacists to dispense the medications in real-time to people who typically do not have access to our normal clinical or research venues including women, justice-involved persons, immigrants, the uninsured, and underrepresented minorities. I have the experience, the passion, the work ethic and the collaborative team to help end HIV in PWUD through this pioneer award.