HIV intervention program will leverage telehealth to reach injection drug users
For the past five years, Hansel Tookes, M.D., M.P.H., assistant professor of clinical medicine in the Division of Infectious Diseases at the University of Miami Miller School of Medicine, has focused on developing community-based engagement in care interventions for persons living with HIV/AIDS and people who inject drugs (PWID).
Now, Dr. Tookes has an opportunity to build a new model of care for this marginalized community after receiving a prestigious Avenir Award from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH). The $2.3 million, four-year Avenir Award will support his innovative research project, “Tele-Harm Reduction for Rapid Initiation of Antiretrovirals in People Who Inject Drugs: A Randomized Controlled Trial.”
“Our school is a national leader in community research and clinical care thanks to forward-thinking faculty members like Dr. Tookes,” said Henri R. Ford, M.D., M.H.A., dean and chief academic officer. “This is a very important study that could lead to a new model for delivering vital care to difficult-to-reach, marginalized populations.”
Dr. Tookes said this intervention will leverage telehealth technology, as well as the trust the Miller School IDEA syringe services program (SSP) has built in the community. He added that leveraging the current SSP framework has great promise as an adaptable and transformative model for bringing HIV care out of a traditional health care clinic, as well as sustaining viral suppression among people who inject drugs living with HIV, increasing use of medications for opioid use disorder and curing patients with hepatitis C virus.
Intervention rooted in harm reduction
“This NIH-funded randomized study, which will involve sites in Tampa as well as Miami, could change the standard of care for people who inject drugs,” Dr. Tookes said. “That would improve health outcomes for this disadvantaged population and reduce health inequities in our communities.” The intervention is rooted in harm reduction, a philosophy that respects the autonomy of PWID and prioritizes meeting them where they are. “Tele-harm reduction uses peers with lived experience to overcome the digital divide by bringing technology directly to people, with the goal to foster engagement in care,” he added.
Dr. Tookes said the Tele-Harm Reduction intervention employs SSPs to deliver telehealth-enhanced access to a physician, psychologist, on-site phlebotomy, medication storage and delivery, as well as harm-reduction counseling.
“This is a concierge program with three physicians on call with rotating schedules to respond to our patients, who might engage with us from their homes, the SSP or our mobile unit, or on street outreach,” he said. “In any case, we can stay connected to them regardless of location.”
This intervention is built upon a foundation of formative work Dr. Tookes conducted under “Ending the HIV Epidemic” grants through the Miller School’s NIH-funded Center for AIDS Research and NIH-funded CHARM Center. Dr. Tookes piloted the program last year, beginning in February before the COVID-19 pandemic led to wider national adoption of telehealth programs.
The right study at the right time
“We were able to achieve viral suppression in 80% of patients who participated, so we knew this could be an efficacious approach,” he said. “Now, this is truly the right study at the right time.”
For Dr. Tookes, the award marks another accomplishment in his career as a clinician, researcher and advocate for individuals facing the multiple stigmas of HIV/AIDS, substance use disorders, and other comorbidities. In 2016, he founded the first legal SSP in Florida with the goal of increasing access to the tools necessary to improve health among the state’s most vulnerable residents. He began his career in harm reduction in the Sociomedical Sciences Research Group at the Miller School with his mentor, Lisa Metsch, Ph.D., now dean of the Columbia School of General Studies and professor at the Mailman School of Public Health at Columbia University. Dr. Metsch and Dan Feaster, Ph.D., professor of public health sciences at the Miller School, will serve as primary mentors for the Avenir project.
“As a Black physician, my push to improve health outcomes in underrepresented communities has been rooted in racial justice,” said Dr. Tookes. “Viral suppression in this high-incidence group is urgently needed, particularly in South Florida, an epicenter of substance use and HIV.”
NIDA’s Avenir Awards provide grants to early-stage investigators who propose highly innovative studies. “Avenir” is the French word for “future,” and these awards represent NIDA’s commitment to supporting researchers who represent the future of addiction science.