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Study: Innovative Miller School Program Prevents HIV Transmission Among People Who Inject Drugs

A rapid identification and intensive case management program developed by Miller School of Medicine clinicians prevented HIV transmission among people who inject drugs in Miami-Dade County’s homeless population.

Drs. Felicia Knaul and Hansel Tookes outside the IDEA Exchange.
Drs. Felicia Knaul and Hansel Tookes outside the IDEA Exchange.

“We were able to identify seven new acute HIV infections among people who inject drugs taking part in the UM IDEA Syringe Services Program, and get them rapidly into treatment,” said Hansel Tookes, M.D., M.P.H., assistant professor of clinical medicine in the Division of Infectious Diseases. “After our team’s intervention, all seven reduced their viral loads to undetectable levels, preventing the transmission of HIV within the network.”

Dr. Tookes was the lead author of the study, “Rapid Identification and Investigation of an HIV Risk Network Among People Who Inject Drugs – Miami, FL, 2018,” that was published recently in the journal AIDS and Behavior. Miller School co-authors were Felicia Knaul, Ph.D., Tyler S. Bartholomew, Edward Suarez, Jr., Psy.D., David W. Forrest, and Leah Colucci.

“Prevention of HIV outbreaks among people who inject drugs remains a challenge to ending the HIV epidemic in the United States,” said Dr. Knaul, who is professor of public health sciences and director of the Institute for Advanced Study of the Americas. “This study can be a game changer that catalyzes a new set of opportunities for action. It shows that providing wrap-around services through the syringe services program, including routine screening, intensive linkage and patient navigation, could be an effective model for achieving viral suppression for people who inject drugs.”

In 2017, the Miller School launched the IDEA Syringe Services Program as the first legal program in Florida and later implemented routine opt-out screening for HIV and hepatitis C (HCV). After the change in protocol in early 2018, the team identified the newly infected individuals, and began the process of getting them into treatment.

“We connected all the patients in the study to HIV care, treatment for substance use disorders and shelter as needed,” said Dr. Suarez. “We also developed the process for medication management so that our people who inject drugs were able to take their medications every day in order to reduce their viral loads. It was done with tact, a smile, a willingness to do good in this world, and a lot of compassion toward those in need of help.”

The study showed the importance of integrating wraparound services at syringe services programs, said Bartholomew, a Ph.D. student in prevention science who applied for the Gilead FOCUS grant and designed the HIV/HCV testing protocol at IDEA. “It took intensive case management services to get our patients from the streets, to the clinic, to the pharmacy, and to shelter and treatment as needed,” he said. “Using a syringe services program for services beyond the exchanges of syringes can have an important impact on the community.”

Dr. Tookes noted that the IDEA team collaborated with the Florida Department of Health to conduct an epidemiologic investigation of the seven acute cases. “A molecular analysis found little genetic connection among the cases, indicating a broader risk network not limited to participants at IDEA,” he said.  All seven were linked to care and achieved viral suppression in less than three months (mean 70 days). Since these initial infections have been treated, no further cases have been identified.

“Our study shows that given the opportunity and support, people who inject drugs can be very successful in HIV care,” said Dr. Tookes. “Our approach is now being used as a model for an aggressive approach to testing and intervention for populations affected by both substance use disorder and HIV.”

Tags: Dr. Felicia Knaul, Dr. Hansel Tookes, HIV/AIDS, IDEA Syringe Services Program