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

项目摘要： 美国（US）结束艾滋病毒流行（EHE）计划的主要目标是减少新的艾滋病毒感染者的数量。 到2030年，艾滋病毒感染率将下降90%，但除非我们找到方法， 为吸毒者提供的服务（PWUD）。在美国，药物过量死亡人数急剧增加， 芬太尼和兴奋剂正在助长新的艾滋病流行。我的事业和激情都围绕着 阿片类药物使用障碍（OUD）和其他物质使用障碍治疗与艾滋病毒治疗相结合 和预防通过20多年的直接临床护理作为一种传染病和成瘾药物 医生结合大量的临床研究专业知识，涉及艾滋病毒感染者和艾滋病毒风险，我 我知道EHE计划中的盲点，我可以用这个先锋奖来填补它们。我的开拓奖 愿景是：1）培训生活在受高剂量影响的社区的人成为社区成员， 卫生工作者（CHW）提供艾滋病毒检测和OUD的快速诊断; 2）创建移动的中心， 移动式药房和诊所可立即分发暴露前预防药物 （PrEP）、抗逆转录病毒疗法（ART）和任何地方的OUD药物治疗（MOUD）; 3）发展迅速 可部署的移动的快速反应小组（移动的辐条）由社区卫生工作者和药剂师组成， 小时访问在线临床医生，这些临床医生从移动的中心部署到CHW确定将 药物（基于快速艾滋病毒检测结果的PrEP/ART，以及诊断为 OUD）人们“居住”的地方;以及4）与研究人员（包括建模人员）合作，优先考虑 艾滋病毒的爆发是最有可能发生的，并为艾滋病毒领域的其他工作人员提供了一个合作中心 和物质使用障碍，以帮助告知这个拟议的护理模式。通过这个奖项，我也将确保 移动的快速反应小组继续跟踪人们，帮助他们保留药物， 解决相互竞争的需求，消除获得服务的障碍。因此，这位先驱者的总体想法 该奖项是在多个接入点提供低障碍服务，符合EHE计划，我们将在 将测试和治疗计划（MOUD，PrEP/ART）带到PWUD，并通过非 传统的方法，他们住的地方。通过使用居住在社区的受过训练的人（CHW） 与吸毒、高危或感染艾滋病毒的社区成员分享生活经历， 我们可以提供检测和诊断服务，并与药剂师一起分发药物， 实时提供给通常无法访问我们正常临床或研究场所的人员，包括 妇女、涉及司法的人、移民、没有保险的人和代表性不足的少数群体。我有 经验，激情，职业道德和协作团队，通过这一点帮助结束艾滋病毒在PWUD 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.