Tele-Harm Reduction for Rapid Initiation of Antiretrovirals in People who Inject Drugs: a Randomized Controlled Trial

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Project Summary I am an early stage physician scientist applying for a NIDA-funded Avenir Award focused on studying the efficacy of Tele-Harm Reduction for HIV treatment based in syringe services programs (SSPs). After years of research and testimony on this evidence-based intervention, I founded the first legal SSP in Florida with the goal of increasing access to the tools necessary to keep people healthy, especially those who are most vulnerable. The program, named IDEA, is housed within the University of Miami, and we have cultivated the program as a “home base” for persons who inject drugs (PWID) by adding a free clinic to bring essential medical services to the community. As a black physician, my push to improve health outcomes in minority communities has been rooted in racial justice. IDEA opened on World AIDS Day in 2016 and has a clinical and research infrastructure rooted in harm reduction and evidenced-based interventions to engage PWID living with HIV. Viral suppression in this high incidence group is urgently needed, particularly in South Florida, an epicenter of substance use, HIV and now COVID-19. PWID are an under-resourced, high HIV incidence community that has suboptimal health outcomes in care and have experienced multiple HIV outbreaks in recent years. Unfortunately, there are few evidence-based interventions to engage PWID living with HIV in care and promote viral suppression, and none to our knowledge in harm reduction settings. Adapting a low threshold, comprehensive treatment model for PWID living with HIV can leverage trusted SSPs to increase availability of antiretrovirals, medications for opioid use disorder, and HCV cure. We developed a Tele-Harm Reduction intervention based on psychosocial and structural burden aspects of the syndemics theoretical framework. Preliminary data suggest that SSP-based telemedicine for HIV is feasible and acceptable. For this Avenir Award, we aim to conduct a methodologically rigorous RCT to assess its efficacy and cost-effectiveness versus current standard-of-care patient navigation services. The Tele-Harm Reduction intervention employs SSPs to deliver telehealth-enhanced access to a physician, on-site phlebotomy, medication storage and delivery, access to medications for opioid use disorder and mental health, substance use disorder and harm reduction counseling all integrated with standard syringe services (i.e. provision of syringes, naloxone, wound care). Tele-Harm Reduction brings medical care out of the clinic and meets PWID where they are, both physically (whether at the SSP or on street outreach) and emotionally (whether ready to reduce drug use or not). Outcomes of interest will include: 1) achieving and sustaining viral suppression among PWID living with HIV; 2) increasing engagement in medications for opioid use disorder; and 3) curing HCV. Leveraging the SSP framework has great promise as an adaptable model for low threshold care in the South and in resource limited settings, bringing HIV care out of a traditional healthcare clinic, a critical step to any comprehensive Ending the HIV Epidemic plans.