New NIH Grant Expands Tele-Harm Reduction Initiative

Supported by a new $3.1 million grant from the National Institutes of Health (NIH), University of Miami Miller School of Medicine public health researchers are taking an innovative approach to connect high-risk individuals in marginalized settings with HIV prevention, treatment and support services.

Dr. Tookes exchanges sterile needles for used ones.
Dr. Tookes exchanges sterile needles for used ones. (Photo courtesy of the National Institute on Drug Abuse.)

“We are circumventing the traditional medical system to connect our physicians with people who inject drugs,” said Tyler Bartholomew, Ph.D., assistant professor of public health sciences.  “Through the use of tablets, our peer navigators break through the stigmas and help these individuals access clinic services when needed.”

Dr. Bartholomew, joined by Hansel Tookes, M.D., M.P.H., clinical director of the IDEA Exchange and associate professor of infectious diseases, will lead the five-year NIH grant for the Miller School’s Comprehensive Tele-Harm Reduction program.

‘One-Stop’ Outreach Program to Help Reduce HIV

“Our goal is to see whether this ‘one-stop’ outreach program can reduce the incidence of HIV, as well as hepatitis C virus (HCV), sexually transmitted infections, opioid use disorders and deaths in our community,” he said.

The program is the latest step forward for the school’s IDEA Exchange, a syringe service program designed to reduce hospitalizations and deaths for individuals with opioid use disorders who were injecting drugs.

“Our experience as founders and leaders of the first legal syringe services program in Florida is that the traditional health care system is not always an ideal venue to engage marginalized individuals,” said Dr. Tookes. “Instead, these programs allow people who inject drugs to experience a positive, non-judgmental, supportive care that facilitates healthy behaviors. It’s a version of concierge medicine for those most in need of care.”

Program Builds on IDEA Exchange’s Previous Success

Dr. Tookes said the success of the Miami IDEA Exchange led to the formation of five more syringe services programs in Florida, while the HIV/HCV testing protocol created at the IDEA Exchange by Miller School researchers has already been added to the U.S. Centers for Disease Control compendium of evidence-based interventions.

In 2021, Dr. Tookes received a $2.5 million Avenir Award from the National Institute on Drug Abuse to test a pilot tele-harm reduction intervention for HIV viral suppression. Using on-site, peer-driven systems of care to support treatment, the pilot program demonstrated its promise as 78% of people with HIV who injected drugs achieved viral suppression six months after enrollment. Funded by the Avenir Award, the efficacy trial is underway.

“Building on this work, we will seek to adapt and test a comprehensive tele-harm reduction model to address the HIV prevention and substance use needs of these communities more fully,” said Dr. Tookes. “It is an important step for our community, as Miami has one of the highest rates of HIV infections in the nation.”

Dr. Bartholomew said one of the three goals of the new NIH-funded study is evaluating the efficacy of the tele-harm reduction program compared with off-site clinic referral and patient navigation for engagement in HIV prevention. The researchers will also perform an economic evaluation of the program and assess its scalability for future sites throughout the U.S.

“With this paired trial, we seek to transform the way our patients access health care, and change the standard of care in this long overlooked community,” said Dr. Tookes. “Our study has the potential for a transformative impact nationwide.”

Tags: Dr. Hansel Tookes, Dr. Tyler Bartholomew, HCV, HIV prevention, IDEA Exchange, Infectious diseases, NIH grant