A new, specially designed vehicle — the PrEP Mobile Clinic — is helping the University of Miami Miller School of Medicine enhance its ability to deliver pre-exposure prophylaxis (PrEP) medication to at-risk communities.
The two-year-old program’s testing and treatment services are offered at no cost, regardless of insurance status.
PrEP treatment is more than 99% effective in preventing HIV infection when taken consistently, and the federal Centers for Disease Control and Prevention estimates that 1.1 million people in the U.S. would benefit from PrEP.
The need for PrEP
Miami has the highest rate of new HIV infections of any city in the country, according to Susanne Doblecki-Lewis, M.D., M.S.P.H., associate professor of clinical medicine in the Miller School’s Division of Infectious Diseases. Her goal is to increase access to PrEP via the mobile clinic at sites across Miami-Dade.
“It’s more relevant here than anywhere, really, to have effective prevention strategies available and on the table for those who need them,” said Dr. Doblecki-Lewis, who recently opened and oversees an on-campus clinic that offers many of the same services without scheduling or geographic restrictions.
The continuation of testing and treatment is more important than ever during the COVID-19 pandemic, Dr. Doblecki-Lewis explained. While the mobile clinic had to pause operations temporarily, the Miller School continued community outreach through other care outlets, such as telehealth and home delivery of testing kits.
A legacy of community outreach
From pioneering some of the first drug therapies for HIV and AIDS, creating Florida’s first needle exchange, and developing strategies to reduce mother-to-child HIV transmission, the Miller School has a decades-long commitment to HIV and AIDS research, as well as outreach to at-risk community populations. One tangible outcome of this legacy of research and service is the PrEP Mobile Clinic.
The idea for a mobile clinic grew out of the need to circumvent the often complex and confusing web of access to PrEP, as well as the stigma surrounding HIV. Dr. Doblecki-Lewis was an investigator in a National Institutes of Health study evaluating the real-world use of PrEP when the FDA approved the drug in 2012. That experience helped her understand the specific challenges Miami residents experience when trying to engage in PrEP care.
“PrEP is a health care intervention, so access to PrEP depends on access to health care,” Dr. Doblecki-Lewis said. “All of the usual determinants of health and access to care come into play.” The mobile clinic provides testing and treatment for sexually transmitted infections and rapid linkage to HIV care.
A cancer and HIV prevention alliance
The PrEP mobile clinic initially received funding from the City of Miami Beach and the Florida Department of Health for staff, labs and in-kind STD testing services via the Miami-Dade Health Department. That still left the need for a vehicle. The team initially approached Sylvester Comprehensive Cancer Center at the Miller School about forming a partnership to share Sylvester’s GameChanger Vehicle, and a cancer and HIV prevention alliance was born. The alliance continued until the arrival of COVID caused operations to cease in March.
PrEP outreach resumed in October after the new vehicle was delivered. Having their own mobile clinic, outfitted with equipment specifically suited for the PrEP mission, has given Dr. Doblecki-Lewis and her team much greater flexibility in scheduling their services.
The Miller School is participating in multiple studies related to PrEP treatment. Additional grants have allowed the mobile clinic team to partner with the Florida Department of Health’s epidemiology branch and other community organizations to identify concentrated areas of HIV diagnoses more accurately. The mobile clinic can then target outreach to those specific areas, improving access to PrEP.